Evidence-based recommendations on care for breast cancer survivors for primary care providers: a review of evidence-based breast cancer guidelines

Objective

To review evidence-based (EB) recommendations on survivorship care for primary care providers (PCPs) in EB breast cancer guidelines.

Design and setting

Guidelines were collected via experts and via literature database, guideline database and cancer agency websites searches.

Method

EB guidelines in any language published between 2012 and 2017 were collected. EB recommendations on survivorship care relevant for PCPs were extracted and grouped into three categories (recurrence detection, long-term effects and recurrence prevention). The content of the recommendations was analysed and summarised in the number and type of clinical topics addressed. The Appraisal of Guidelines for Research and Evaluation II instrument was used to evaluate the methodological quality of the guidelines.

Results

Six guidelines, of which two were of acceptable methodological quality, were included. One was specifically made for general practitioners. Fifteen clinical topics were identified. Guidelines differed in the clinical topics addressed and for some identical topics in the content of the recommendations. Many recommendations were based on low-quality evidence. Recurrence detection received most attention, physical examination and mammography were often highlighted. Potential complications largely varied in number and type. Intimacy concerns, vaginal dryness, dyspareunia, fatigue, menopausal symptoms, peripheral neuropathy and lymphedema were reported in more than one guideline. Recurrence prevention was mentioned in four guidelines; all recommended physical activity.

Conclusion

The number of EB recommendations in guidelines is limited. Moreover, recommendations differ between guidelines and most are based on low-quality evidence. More high-quality research is needed to develop and adapt guidelines to support PCPs in providing optimal breast cancer survivorship care.

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Do psychological harms result from being labelled with an unexpected diagnosis of abdominal aortic aneurysm or prostate cancer through screening? A systematic review

Objective

A potential psychological harm of screening is unexpected diagnosis—labelling. We need to know the frequency and severity of this harm to make informed decisions about screening. We asked whether current evidence allows an estimate of any psychological harm of labelling. As case studies, we used two conditions for which screening is common: prostate cancer (PCa) and abdominal aortic aneurysm (AAA).

Design

Systematic review with narrative synthesis.

Data sources and eligibility criteria

We searched the English language literature in PubMed, PsychINFO and Cumulative Index of Nursing and Allied Health Literature (CINAHL) for research of any design published between 1 January 2002 and 23 January 2017 that provided valid data about the psychological state of people recently diagnosed with early stage PCa or AAA. Two authors independently used explicit criteria to review and critically appraise all studies for bias, applicability and the extent to which it provided evidence about the frequency and severity of harm from labelling.

Results

35 quantitative studies (30 of PCa and 5 of AAA) met our criteria, 17 (48.6%) of which showed possible or definite psychological harm from labelling. None of these studies, however, had either appropriate measures or relevant comparisons to estimate the frequency and severity of psychological harm. Four PCa and three AAA qualitative studies all showed clear evidence of at least moderate psychological harm from labelling. Seven population-based studies found increased suicide in patients recently diagnosed with PCa.

Conclusions

Although qualitative and population-based studies show that at least moderate psychological harm due to screening for PCa and AAA does occur, the current quantitative evidence is insufficient to allow a more precise estimation of frequency and severity. More sensitive measures and improved research designs are needed to fully characterise this harm. In the meantime, clinicians and recommendation panels should be aware of the occurrence of this harm.

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Aberrant left renal vein: CT

A 25 yrs old married woman c/o abdominal pain and nausea for 1 day.  Pregnancy test –ve. CT scan revealed an anomalous and elongated left renal vein draining into the left common iliac vein. Left renal vein is elongated with an aberrant para-aortic virtually vertical course.

Case Submitted by Dr. Abduladeem Al-Tamimi, MD, DMRD, FRCR, Consultant Radiologist

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Naso-jejunal tube insertion - interface between radiology and endoscopy.

Related Articles

Naso-jejunal tube insertion - interface between radiology and endoscopy.

World J Radiol. 2017 Nov 28;9(11):413-415

Authors: Riddel N, Thoufeeq MH

Abstract
A survey was performed to identify the practice associated with endoscopic placement of naso-jejunal (NJ) tubes. We had a total of 236 responses, of which 228 responded to the frequency of requesting X-ray after placing NJ tubes. The responses suggested that there was a strong variation in the practice. The practice was independent on clinicians' area of interest, hospital setting or experience in endoscopy. Currently there are no accepted guidelines on this. Hence, we advise hospitals to have robust local guidelines until there is internationally agreed consensus.

PMID: 29225738 [PubMed]

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Comparison of seldinger and trocar techniques in the percutaneous treatment of hydatid cysts.

Related Articles

Comparison of seldinger and trocar techniques in the percutaneous treatment of hydatid cysts.

World J Radiol. 2017 Nov 28;9(11):405-412

Authors: Turan HG, Özdemir M, Acu R, Küçükay F, Özdemir FAE, Hekimoğlu B, Yıldırım UM

Abstract
AIM: To comparatively evaluate Seldinger and Trocar techniques in the percutaneous treatment of hydatid disease.
METHODS: Trocar and Seldinger techniques were used for 49 and 56 cysts, respectively, among 106 hydatid cysts in 88 patients. The number of males and females were 22 and 66, respectively with a mean age of 44.9 years (range, 15-87). Follow-up studies included cyst diameter, cyst contents, and morphological changes in the cyst wall, local recurrence, and secondary invasion, using ultrasound, computerized tomography and chest X-rays.
RESULTS: The positive criteria of healing were a decrease in cyst diameter, progressive solidification of the cyst contents, and disappearance of the cyst. Local recurrence was defined as an increase in the cyst diameter and contents, and appearance of daughter cysts in the primary cavity, while secondary dissemination was defined as the appearance of new cysts outside the treated cyst. Mean duration of follow-up was 19.23 mo (range, 18-26 mo). Follow-up results demonstrated that no significant differences were present between the Trocar and Seldinger techniques in the percentage of decrease in the cyst volume, rate of early complications, local recurrence and secondary dissemination (P = 0.384, 0.069, 0.215 and 0.533, respectively).
CONCLUSION: There are no differences between the Seldinger and Trocar techniques that gain entry to the cyst cavity in terms of the efficacy of the treatment and the rates of early and late complications.

PMID: 29225737 [PubMed]

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Serial 4DCT/4DPET imaging to predict and monitor response for locally-advanced non-small cell lung cancer chemo-radiotherapy

A FDG-PET/CT image feature with optimal prognostic potential for locally-advanced non-small cell lung cancer (LA-NSCLC) patients has yet to be identified, and neither has the optimal time for FDG-PET/CT response assessment; furthermore, nodal features have been largely ignored in the literature. We propose to identify image features or imaging time point with maximal prognostic power.

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Exposure of the lungs in breast cancer radiotherapy: A systematic review of lung doses published 2010–2015

We report a systematic review of lung radiation doses from breast cancer radiotherapy.

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