Synchronous Operable Pancreatic and Breast Cancer Without Genetic Mutation: A Literature Review and Discussion.

Background: Synchronous cancers are rarely detected when working-up a patient for a primary cancer. Neoadjuvant management of synchronous breast and pancreatic cancers, without a germline mutation, has yet to be discussed. Two patients were diagnosed with synchronous breast and pancreatic cancers at our institution over the last decade. A literature review was performed to evaluate the current evidence stance. Results: The first patient was 61-years old and diagnosed with a HER2+ breast cancer. The second patient was 77-years old and diagnosed with a Luminal B breast cancer. The inability to provide concurrent breast and pancreatic neoadjuvant therapy for the HER2+ patient, resulted in upfront surgery. The second patient was able to have both cancers treated simultaneously - neoadjuvant chemotherapy to the pancreas, and neoadjuvant endocrine therapy to the breast. Discuss: There is no single neoadjuvant regimen that treats both pancreatic and breast cancer. The differences in breast cancer sub-types impacted our neoadjuvant options. Our recent experience led us to the hypothesis that breast cancer care dictates treatment, while pancreatic cancer determines survival. There is a significant paucity in the literature regarding synchronous breast and pancreatic cancer.

Satisfaction with general practitioner obstetrician-led maternity care in rural Western Australia.

OBJECTIVE: To measure satisfaction with general practitioner obstetrician-led maternity care in Western Australia and to explore perspectives of maternity service users DESIGN: Women were recruited at antenatal visits with their general practitioner obstetrician. Participants completed a validated three-part survey about their satisfaction with antenatal, intrapartum and postpartum care. They were all offered a semi-structured interview. SETTING: Nine general practitioner obstetrician practices located in regional Western Australia. PARTICIPANTS: 155 women receiving general practitioner obstetrician-led maternity care within the South West or Great Southern regions of Western Australia. 13 of these women also participated in an interview. MAIN OUTCOME MEASURES: We quantified satisfaction with aspects of antenatal, intrapartum and postpartum care using a Likert scale. Descriptive variables included demographic information and birth outcomes. Qualitative data described valued aspects of maternity care. RESULTS: 116 women completed all 3 surveys. General practitioner obstetrician-led care resulted in high rates of satisfaction across all 3 stages of care, with 78%-100% agreement with positively worded satisfaction statements. Thematic analysis identified four key aspects of care women valued when receiving maternity care: the woman-centred care experience, the skills of the general practitioner obstetrician, support from the health care team and the health care environment. CONCLUSION: General practitioner obstetrician-led maternity care is a highly regarded model of maternity care, valued by rural women with high rates of satisfaction.