Radiation treatment for ductal carcinoma in situ (DCIS): is a boost to the tumor bed necessary?

The aim of the presented study was to evaluate the long-term outcome of breast-conserving surgery and radiation for the treatment of ductal carcinoma in situ (DCIS) and the role of the radiation boost to the tumor bed. The files of 75 women with DCIS treated by breast-conserving surgery followed by definitive radiation from 1988 to 1997 were reviewed for demographic data, prognostic variables, radiation dose, radiation boost, recurrence, and outcome. Total radiation dose was 5000 cGy delivered in 25 fractions. Twenty patients (26.7%) received an additional boost to the tumor bed of 1000 cGy in 5 fractions. Median follow-up time was 81.5 months (range, 22-145). Pearson correlation coefficient and its significance was calculated between the variables. Log rank test was used to analyze differences in local recurrence rates between patients who did or did not receive a boost, and a Cox regression model was fitted to the data to predict recurrence. Ten patients (13%) had local recurrence; one patient showed lymphatic spread. Histopathologic examination revealed DCIS in 6 cases (60%) and invasive duct carcinoma in 4 (40%)(one minimally invasive). The recurrence group included 3 of the 20 patients who received a radiation boost (15%) and 7 of the 55 who did not (12.7%) (p=0.7). Correlation analysis of patient characteristics, prognostic factors, and treatment was significant only between mastitis as the presenting symptom (n=4) and longer time to recurrence (p=0.02). The recurrence rate in the present study was similar to other series of conservative treatment for DCIS of the breast. No additional value was found for the radiation boost. Larger controlled randomized studies are needed to confirm these findings.

Social work roles in America's changing health care.

Legislative reform of health care is dead but major changes are taking place in the marketplace and by states. Managed care, cost containment, corporatization and prepayment are revolutionizing health care. What do these portend for social work's future survival in changing locations, tasks, skills and attitudes? Suggested areas of strength and opportunity as well as needed changes are proposed.

Managing the maze: case management and service delivery.

The author discusses case management as the most recent social work effort to make manageable the pluralistic and proliferating array of human services. She notes that social work now claims case management as part of its long defined territory. The ability to make this function work is based upon an educational curriculum which prepares the professional in both direct interventive skills and management capability. Problematically, social work education usually provides the student with only one or the other sets of professional preparation. The importance of the power dimension must be acknowledged and honed if the case manager is to be successful working within a chaotic social service delivery system.

The posthospital needs and care of patients: implications for discharge planning.

Sixty-nine patients hospitalized for a serious illness and discharged to their own or relative's homes were followed up to learn about patient's posthospital needs; sources of help they received and how well they met these needs; and the extent to which hospital social work targets these needs in the discharge planning process. The patients, who were mostly elderly, had substantial needs for care. The family was the major care provider. Although service provision was limited, the social worker had a pivotal role in linking the patient to community services. This exploratory study points to gaps in the hospital screening and discharge planning process.

[Primary-multiple cancer of the breast (from the data of the Chelyabinsk Regional Oncology Dispensary)]. / Pervichno-mnozhestvennyi rak molochnykh zhelez (po materialam Cheliabinskogo oblastnogo onkologicheskogo dispansera).

102 cases of primary multiple breast cancer (bilateral and multicentric tumors-61; synchronous tumors of the breast and genitals-12) were treated at the Regional Oncological Dispensary in Chelyabinsk in 1976-83. Tumors generally occurred in patients of the 40-50 years bracket at an interval of 5.2 +/- 0.3 years. A certain role in the pathogenesis of primary multiple breast cancer was played by reproductive function as well as previous treatment modality (gamma-therapy, cytostatic treatment and ovariectomy).

Surviving DRG's: New Jersey's social work experience with prospective payments.

This is a report of a study which examined the impact of New Jersey's four-year experience with all-payer DRG's upon 82 hospital social work departments as these were reported by their directors. Although DRG's have made discharge planning, and thus social work, central to hospitals' financial health, departments have faced increased caseloads and some refocus of staff deployment, not always with compensatory increases in staff. Strategies to survive the cost-containment policies and other implications are noted.

Social work roles in health care: an educational framework.

Changes in demography, technology, and values have created new health problems and increased the number of people whose needs for service are extensive and complex. The authors describe an educational design intended to prepare social work students for the complicated new roles evolving for workers in health care.

In sickness and in health: future social work roles.

Increasing specialization, rising costs, and the depersonalization of care are some of the problems affecting the delivery of health care in this country. This article discusses the impact of these and other major developments and proposes expanded tasks and functions to be performed by social workers in the future.