Calidad de atención y mejora continua en el abordaje integral del cáncer de mama: Evaluación de indicadores en una Unidad de Mastología / Quality of care and continous improvement in a comprehensive approach of breast cancer management: evaluation of indicators in a breast center

Introducción: las Unidades de Mastología son organizaciones que tienen por objetivo abordar la patología mamaria de manera multidisciplinaria e integral. A nivel mundial se han implementado programas para evaluar la calidad de atención a través del cumplimiento de indicadores propuestos por Sociedades Científicas u organismos gubernamentales. Algunos de estos han sido propuestos y revisados por la Sociedad Europea de Mastología (EUSOMA). Objetivo: evaluar la calidad de atención de la Unidad de Mastología del Hospital Juan A. Fernández a través del análisis de una serie de indicadores propuestos por EUSOMA como estándares de calidad de atención en centros de patología mamaria. Material y método: estudio descriptivo retrospectivo analizando la base de datos de las pacientes con cáncer de mama estadios 0 a III operadas entre 2015 y 2019. Se analizaron 25 indicadores de procesos propuestos por EUSOMA en 2017. Se registraron las características de la población, y el porcentaje de pacientes en las cuales se cumple la condición de cada uno de los indicadores. Se registró si el indicador alcanza o supera el mínimo estándar, o si alcanza o supera el valor ideal. Resultados: se evaluaron 284 pacientes. Se observó el cumplimiento de la mayoría de los estándares propuestos (18 de 25), alcanzando o superando en el 25% de los indicadores evaluados el valor ideal. Se lograron alcanzar los estándares de calidad de atención relacionados con el diagnóstico clínico y preoperatorio, caracterización anatomopatológica completa en carcinoma invasor, evaluación multidisciplinaria, tratamiento quirúrgico primario en carcinoma invasor e in situ. Se alcanzaron los objetivos tendientes a evitar el sobretratamiento quirúrgico en carcinoma invasor y en cirugía conservadora en carcinoma in situ. En relación a los tratamientos adyuvantes, se alcanzaron los estándares relacionados con radioterapia post cirugía conservadora y post mastectomía, así como también el tratamiento con hormonoterapia y quimioterapia. El seguimiento de los pacientes se realizó en tiempo en tiempo y forma de acuerdo al indicador establecido. Existen 3 indicadores de calidad obligatorios en los que no se alcanzó el estándar mínimo: se observó la necesidad de mejorar la accesibilidad a los tratamientos antiHer2neu en neoadyuvancia, y de reducir los tiempos de espera al inicio del tratamiento. Conclusiones: se observó el cumplimiento de la mayoría de los estándares propuestos. Dado que existen indicadores obligatorios en los que no se alcanzó el estándar mínimo, los esfuerzos primarios deberán centrarse prioritaria e inicialmente en diseñar una planificación que permita alcanzar estos objetivos, así como también mantener en el tiempo los valores positivos ya alcanzados. Se pone de manifiesto la necesidad de implementar políticas a nivel sanitario nacional que permitan mejorar la accesibilidad a medicación oncológica. A su vez, destacamos la importancia de definir indicadores propios con valores ajustados a las características de nuestro país y mantener una evaluación periódica de la calidad de atención a través de los mismos.

Introduction: Breast Units are organizations that manage Breast Cancer in a comprehensive and multidisciplinary approach. Worlwide, programs have been developed in order to evaluate quality of care through the achievement of certain standards of care that have been proposed by scientific organizations, medical associations or government health departments. Some of these indicators have beeb proposed by the European Society of Breast Cancer Specialist (EUSOMA). Objective: to evaluate quality of care in the Breast Unit at Hospital Juan A Fernández (Buenos Aires, Argentina) through the analysis of a series of indicators described by EUSOMA as standard of care in breast centers. Material and method: we performed a descriptive, retrospective analysis of our database including patients with breast cancer stage 0 to III that wer treated between 2015 and 2019. We studied 25 quality of care process indicators proposed by EUSOMA in 2017. We registered population characteristics and the percentage of patients in which each indicator mínimum requirements were achieved. We also studied whether our results achieved or were beyond the ideal targets for each indicator. Results: a total of 284 patients were evaluated. The mínimum standard of care was achieved in most of the evaluated indicators (18 of 25) and in 25% of these, our results achieved or exce3ded the ideal requirements. The indicators in which the mínimum or ideal standard of care was accomplished were regarding clinical and preoperative diagnosis anatomopathological characterisation in invasive breast cancer, multidisciplinary approach, primary surgical management in invasive and in situ breast cancer, avoidanc of overtreatement in invasive breast cancer and breast conserving therapy in carcinoma in situ. Regarding adjuvant treatment, the standard of care was achieved in radiotherapy after breast conserving surgery and after mastectomy, endocrine therapy and chemotherapy. The follow up timing was according to the indicator. There were 3 mandatory indicators in which the mínimum standards were not achieved and were regarding accesibility to anti Her2neu agents in neoadjuvant setting, and timing form diagnosis to firts treatment. Conclusions: we observed that out Breast Unit achieved most of the quality of care indicators described by EUSOMA. However, there 3 mandatory indicators where the results were below the mínimum. This is why future efforts should be focused on designing and planning new measures that will allow these objectives to be accomplished, as well as maintaining what has already been achived. Our results also show the imperious need to implement national public health pólices that would grant a better accesiblility to oncologic medications. We also analysed the importance of defining our own local quality of care indicators in relation to our health policies and current situation, as well as the importance of a continuous evaluation of quality of care through these indicators.

Abstracts from the brazilian breast cancer symposium, pirenopolis, 2018

Extra edition of mastology, with summaries of the works presented at the Goiania Breast Cancer Symposium (GBCS) held in Pirenopolis, the GBCS name was changed to BBCS Brazilian Breast Cancer Symposium.

Presentación caso clínico / Clinical Case

Paciente femenino de 23 años, sin antecedentes de relevancia, que comienza con cuadro progresivo de múltiples lesiones eritematosas en mama derecha sin comprometer ninguna otra localización. Se realiza tratamiento antibiótico sin mejoría clínica, por lo que se decide internación y toma de biopsia cutánea. La paciente comienza con cuadro neurológico progresivo homolateral al compromiso mamario, con dificultad respiratoria, parestesias bucales, alopecía parcheada y dificultad a la marcha con debilidad funcional homolateral. Se solicitan estudios complementarios de imágenes y laboratorio con resultados dentro de parámetros normales. El resultado de la biopsia informa "Eritema multiforme". Se indica tratamiento psiquiátrico para el componente neurológico y tratamiento sintomático para su patología de base, obteniéndose curación completa en 21 días.

23-year-old female patient, with no relevant medical history, starts with multiple progressive erythematous lesions in the right breast without compromising any other location. An antibiotic treatment is started without clinical improvement, so it's decided to hospitalize and take a skin biopsy. During her stay, the patient begins with ipsilateral progressive neurological symptoms, including respiratory distress, oral paresthesia, alopecía, walking difficulties, among others. cat, mri, laboratory and other test are requested with no abnormal results. The skin biopsy reports Erythema Multiforme. A psychiatric treatment is started for the neurological component and symptomatic treatment for the em, obtaining complete cure in 21 days.

Estadiamento do câncer de mama em mulheres atendidas em um centro de referência em oncologia / Staging of breast cancer in women admitted for care in an oncology reference center

O objetivo do estudo foi avaliar a possível associação entre as características sociodemográficas e o estádio clínico do câncer de mama em mulheres, admitidas para atendimento em um centro de referência em oncologia. Os prontuários de 257 pacientes com diagnóstico de câncer de mama e atendidas entre novembro de 2009 a novembro de 2010 foram revisados. Os dados de interesse foram extraídos para um banco de dados e analisados por meio de regressão logística para identificação das variáveis associadas com o estádio clínico. As pacientes tinham em média 54,5 anos de idade e a maioria eram pardas (62,8%), sem história familiar de câncer de mama (78,2%) e com índice de massa corporal acima do ideal (57,2%). O diagnóstico do câncer foi tardio (estádio III e IV) em 32,7% das pacientes. Não houve associação significativa entre o estádio clínico e a idade, cor da pele, estado civil, índice de massa corpórea ou história familiar de câncer de mama. O percentual de casos diagnosticados em estádio tardio ainda é elevado, quando comparado com o encontrado em países desenvolvidos, o que aponta para necessidade de políticas que facilitem a detecção precoce da doença na região.

The aim of the study was to evaluate the possible association between sociodemographic characteristics and the clinical stage of breast cancer in women admitted for care at an oncology reference center. The medical records of 257 patients treated between November 2009 and November 2010 were reviewed. The data of interest were extracted onto a database and analyzed using logistic regression to identify the variables associated with the clinical stage. The patients were on average 54.5 years of age, primarily Caucasian (62.8%), with no family history of breast cancer (78.2%) and above the ideal body mass index (57.7%). Cancer diagnosis was late (stage II and IV) in 32.7% of patients. There was no significant relationship between the initial or early stages and age, skin color, marital status, body mass index and family history of breast cancer. The percentage of cases diagnosed in a late stage is still high when compared to what is found in developed countries, which points to the need for policies that facilitate the early detection of the disease in the region.

Atención a pacientes con afecciones benignas de la mama durante 11 años / Care for patients with benign breast conditions during 11 years

Se realizó un estudio descriptivo, observacional y retrospectivo de 1 551 pacientes con afecciones benignas de la mama, atendidas en el Hospital Provincial Docente "Mariana Grajales Coello" de Santiago de Cuba durante el período 2001-2011, con vistas a mostrar las características clínicas y el tratamiento de estas afecciones. En la serie predominó la displasia mamaria en sus formas fibrosa (39,3 %), adenosis (27,7) y quística (16,6 %), seguidas del fibroadenoma (12,8 %). El dolor prevaleció en todas las féminas con fibrosis; el nódulo, en todas aquellas con fibroadenomas, quiste y papiloma. La descarga por el pezón, estuvo presente en 100 % de las que presentaron ectasia y papiloma, así como también en 75 % de las que afectadas por adenosis. Se aplicó tratamiento higienicodietético y hormonal a 83,7 y a 53,1 % de las integrantes de la serie, respectivamente. Se concluye que las afecciones benignas de la mama, constituyen una causa importante de morbilidad en las mujeres de cualquier edad.

A descriptive, observational and retrospective study was carried out in 1 551 patients with benign breast conditions, attended in "Mariana Grajales Coello" Provincial Teaching Hospital of Santiago de Cuba during the period 2001-2011 in order to show the clinical characteristics and treatment of these conditions. In the series breast dysplasia prevailed with its fibrous (39.3%), cystic (16.6%) and adenosis (27.7%) forms, followed by the fibroadenoma (12.8%). Pain prevailed in all the females with fibrosis; the pump in all women with fibroadenomas, cyst and papilloma. The nipple discharge was present in 100% of those who had ectasis and papilloma, and in 75% of those affected by adenosis as well. Hygienic-dietetic and hormonal treatment was administered to 83.7 and 53.1% of members of the series respectively. It is concluded that benign breast conditions are an important cause of morbidity in women of all ages.

Factores de riesgo de cáncer de mama en mujeres pertenecientes a un consultorio médico del Centro Urbano "José Martí" / Risk factors of breast cancer in women belonging to a doctor's office from "José Martí" Urban Center

Se efectuó un estudio descriptivo y transversal de 70 féminas mayores de 30 años, pertenecientes al Consultorio Médico de la Familia No.37 del Policlínico Docente "José Martí Pérez" de Santiago de Cuba, desde enero hasta junio del 2011, con vistas a determinar algunos factores de riesgo epidemiológicos asociados al cáncer de mama. Se utilizaron las frecuencias absoluta y relativa como medidas de resumen. Entre los factores de riesgo predominantes figuraron: no realización de ejercicios físicos (84,2 %), sobrepeso u obesidad (50,0 %) y menos de 4 meses de lactancia materna o no ofrecimiento de esta (37,1 %). Se constató que la mayoría de las mujeres realizaban la autoexploración mamaria mensual (54,2 %), pero en 8,7 % de ellas el examen clínico resultó dudoso, por lo cual fueron remitidas a la consulta de Mastología.

A descriptive and cross-sectional study of 70 female patients older than 30 years belonging to the doctor's office No.37 of "José Martí Pérez" Teaching Polyclinic in Santiago de Cuba was carried out from January to June, 2011, aimed at determining some epidemiological risk factors associated with breast cancer. The absolute and relative frequencies were used as summary measures. Among the predominant risk factors there were: no physical exercises (84.2%), overweight or obesity (50.0%) and less than 4 months of breast feeding or no offer of it (37.1%). It was verified that most of the women carried out the monthly breast self-examination (54.2%), but in 8.7% of them the clinical examination was doubtful, reason why they were referred to the Mastology Department.

Ensino em mastologia: proposta de um programa de residência médica / Mastology teaching: residence program proposal

A mastologia foi reconhecida como especialidade médica no Brasil. Este fato assegura o direito à criação e ao reconhecimento oficial da residência médica nesta área da medicina no país. Neste artigo os autores apresentam, em nome da Sociedade Brasileira de Mastologia, uma proposta para a Comissão Nacional de Residência Médica que deverá servir de base para a normatização da estruturação dos programas de residência médica nas instituições interessadas.

Mastology is currently a medical speciality in Brazil. This fact assures the official creation of medical residency programmes in this area in our country. On the behalf of the Brazilian Society of Mastology, the authors hereby present a proposal to the Comissão Nacional de Residência Médica, with the aim of orientating the organization of medical residency programmes in mastology in interested institutions.