Although a recent study showed that hospital mortality and readmission rates were lower for Medicare patients treated by female than male physicians, 1 women physicians are paid less, 2 are less likely to be promoted, 3 and, on average, spend 8.5 more hours per week on household activities, 4 even after adjusting for age, experience, specialty, clinical revenue, and research productivity. One mechanism may be that in current work environments, childbearing and child rearing may limit opportunities and advancement for women physicians. It is not known, however, how motherhood specifically affects perceived discrimination among women physicians.

The 2013 Institute of Medicine report investigating cancer care concluded that the cancer care delivery system is in crisis due to an increased demand for care, increasing complexity of treatment, decreasing work force, and rising costs. Engaging patients and incorporating evidence-based care into routine clinical practice are essential components of a high-quality cancer delivery system. However, a gap currently exists between the identification of beneficial research findings and the application in clinical practice. Implementation research strives to address this gap. In this review, we discuss key components of high-quality implementation research. We then apply these concepts to a current cancer care delivery challenge in women’s health, specifically the implementation of a surgery decision aid for women newly diagnosed with breast cancer.

No abstract

Introduction National Comprehensive Cancer Network (NCCN) guidelines recommend wide excision without axillary staging to treat phyllodes tumors of the breast. Without prospective trials to guide management, NCCN also recommends consideration of radiation therapy (XRT). We describe current patterns of care for the multidisciplinary management of phyllodes tumors. Methods Using Surveillance, Epidemiology and End Results Program (SEER) data, we identified women diagnosed with phyllodes tumors between 2000 and 2012 who underwent surgical therapy. Trends in breast conserving surgery (BCS), nodal sampling and XRT were assessed using the Cochrane-Armitage test. Multivariable logistic regression was used to identify factors associated with treatment. Results Of 1,238 patients, 56.9% underwent BCS and 23.6% underwent nodal sampling (10.5% after BCS vs 40.9% after mastectomy). After surgery, 15.4% received adjuvant XRT (BCS, 12.9% and mastectomy, 18.8%). XRT utilization increased significantly over the study period (BCS, p=<0.0001; mastectomy, p=0.0003) while nodal sampling did not change significantly. Women were more likely to receive mastectomy if they were older or had larger tumors. Nodal sampling was also associated with older age, larger tumor size and receipt of mastectomy. Receipt of XRT was associated with later year of diagnosis, larger tumors and nodal assessment. Conclusion Over time, an increasing number of women received XRT after surgical management of phyllodes tumor, and one in four women underwent nodal sampling. While some of this practice can be attributed to concern about more advanced disease in the absence of strong data, there may be an educational gap regarding current guidelines and appropriate management.

Purpose of review This review examines recent literature on the psychosocial needs of and interventions for young women. We focus on the active treatment period given the toxicity of treatment, the incidence of anxiety, and depressive symptoms in these women during treatment. This review summarizes research relevant to addressing their social and emotional concerns. Recent findings Young women undergoing treatment for breast cancer remain understudied despite unique needs. Psychoeducational interventions help to relieve symptoms and emotional distress during treatment, but effects do not appear to persist over the longer term. In the clinical context, the performance of prognostic-risk prediction models in this population is poor. Surgical decision-making is often driven by fear of recurrence and body image rather than prognosis, and decision aids may help young women to synthesize information to preserve their role in the treatment process. Summary First, shared decision-making, second, balancing body image, fear of recurrence, and recommended treatment, and third, palliative care for metastasis are essential research priorities for the clinical setting. In the larger social context, unique family/partner dynamics as well as financial and insurance concerns warrant particular attention in this population.