Association Between Electronic Patient Symptom Reporting With Alerts and Potentially Avoidable Urgent Care Visits After Ambulatory Cancer Surgery.

Importance: Increasingly complex surgical procedures are being performed in the outpatient setting, increasing the burden on patients and caregivers to manage their postoperative symptoms. Electronic patient-reported symptom tracking may reduce this burden and help patients distinguish between expected symptoms and those requiring intervention. Objective: To determine whether electronic symptom reporting with clinical alerts for 10 days after ambulatory cancer surgery is associated with a reduction in potentially avoidable urgent care visits, defined as a visit not leading to admission. Design, Setting, and Participants: This retrospective cohort study was conducted at the Josie Robertson Surgery Center (JRSC), Memorial Sloan Kettering Cancer Center's ambulatory surgery center with overnight stay capacity from September 20, 2016, to December 31, 2018. Patients undergoing prostatectomy, nephrectomy, mastectomy with or without immediate reconstruction, hysterectomy, or thyroidectomy at the surgery center before (n = 4195) and after (n = 2970) implementation of the Recovery Tracker (RT) electronic postoperative symptom survey were included. Data analyses were conducted from February 1 to November 24, 2020. Exposures: A short electronic survey assessing symptoms daily for 10 days after surgery, administered via the patient portal, with alerts to the clinical team and follow-up for concerning responses. Main Outcomes and Measures: The main outcome was Memorial Sloan Kettering urgent care center visits with and without readmission and any readmission within 30 days after surgery. Nursing workload was measured by patient phone calls, emails, and secure messages as documented in the electronic medical record. Results: A total of 7165 patients were analyzed, including 4195 (median age, 53 [interquartile range (IQR), 44-63] years; 3490 women [83%]) from the pre-RT implementation period and 2970 (median age, 56 [IQR, 46-65] years; 2221 women [75%]) from after full implementation. On multivariable, intent-to-treat analysis by study period, having surgery in the post-RT period was associated with a 22% decrease in the odds of an urgent care center visit without readmission (OR, 0.78; 95% CI, 0.60-1.00; P = .047). Having responded to at least 1 survey was associated with a 42% reduction in the odds of an urgent care center visit without readmission (OR, 0.58; 95% CI, 0.39-0.87; P = .007). There was no change in the risk of admission. Nursing calls increased by a mean of 0.86 (95% CI, 0.75-0.98) calls per patient after RT implementation (P < .001), a 34% increase. Conclusions and Relevance: In this cohort study, electronic symptom reporting with nursing follow-up for clinical alerts was associated with a reduction in potentially avoidable urgent care visits. The low risk and high benefit of this intervention suggest that these systems should be more broadly implemented.

Infusion Site Reactions: Classification in the Setting of Fosaprepitant Administration With Chemotherapy.

BACKGROUND: Studies report a wide range of incidence and severity of infusion site adverse events (ISAEs) following fosaprepitant administration. OBJECTIVES: The purposes of this study were (a) to determine the incidence of suspected extravasation in patients with cancer receiving fosaprepitant infusions with chemotherapy and (b) to determine whether the documented signs, symptoms, and management strategies aligned with the diagnostic criteria for extravasation versus non-extravasation ISAEs. METHODS: Electronic health records were used to identify patients who received fosaprepitant infusion with chemotherapy and had documentation for suspected extravasation. Chart reviews were conducted for a sample of patients to determine whether documentation was consistent with extravasation. FINDINGS: About 3% (n = 460 of 15,667) of patients who received fosaprepitant had documentation for suspected extravasation. Among a random sample of patients (N = 110) with suspected extravasation, 6% (n = 6) had documentation consistent with extravasation.

Response to "Male Patients With Breast Cancer: Addressing Needs Using an Educational Task Force"

Male breast cancer is associated with hereditary risk for developing breast and other cancers. An estimated 4% of men with breast cancer have BRCA1 mutations, and 4%-16% have BRCA2 mutations. Men with a diagnosis of breast cancer have unique needs that need to be addressed in a caring and comprehensive manner.

CE: Breast Cancer Screening: A Review of Current Guidelines.

: Breast cancer accounts for more than a quarter million diagnoses each year in the United States. Routine screening is the primary method used to detect cancer in its earliest stages, before symptoms develop. Recent changes to national screening guidelines have resulted in a lack of consensus and confusion among health care providers and the public. This article reviews the guidelines of the American Cancer Society, the U.S. Preventive Services Task Force, and the National Comprehensive Cancer Network and provides guidance to nurses as they support and educate patients.

Sentinel lymph node biopsy and axillary dissection: added morbidity of the arm, shoulder and chest wall after mastectomy and reconstruction.

Axillary lymph node surgery is essential for the treatment of breast cancer but can produce both short-term and long-term morbidities, including lymphedema, shoulder restriction, numbness, weakness, and pain syndromes which impact on the quality of life of the estimated 2 million breast cancer survivors living in the United States today. They occur with both sentinel node biopsy and axillary dissection, though less frequently with the former. The incidence and etiology of these complications are investigated as are the risk factors, and methods of prevention and treatment. Recommendations for avoiding these morbidities for postoperative rehabilitation are discussed.

Surgical management of breast cancer.

OBJECTIVES: To review the surgical treatment options for breast cancer and breast reconstruction options following mastectomy. DATA SOURCES: Clinical and research articles, textbook chapters, and clinical practice. CONCLUSION: Advances have been made in the surgical treatment of breast cancer, and options for less invasive procedures are now available. Patients are often faced with difficult decisions when trying to choose the best treatment option. IMPLICATIONS FOR NURSING PRACTICE: Nurses play an integral role in providing patients with the physical, educational, and emotional skills necessary to help them make appropriate surgical decisions and return to optimal health after their treatment.

Eighteen sensations after breast cancer surgery: a 5-year comparison of sentinel lymph node biopsy and axillary lymph node dissection.

BACKGROUND: The aim of this study is to evaluate prevalence, severity, and level of distress of 18 sensations at baseline (3-15 days) and 5 years after breast cancer surgery, and compare sensations after sentinel lymph node biopsy (SLNB) with those after SLNB plus immediate or delayed axillary lymph node dissection (ALND). METHODS: A total of 187 patients with breast cancer completed the Breast Sensation Assessment Scale at baseline and at 3, 6, 12, 24, and 60 months after surgery to assess prevalence, severity, and level of distress of sensations. Of these, 133 had SLNB, and 54 had SLNB and ALND. Additionally, of the 187 patients, 141 had breast-conservation therapy and 46 had total mastectomy. RESULTS: Sensations were less prevalent, severe, and distressing after SLNB compared with ALND at baseline and at 5 years. This difference was most evident in those who had breast-conservation therapy. Most sensations after SLNB and ALND, even if prevalent, were not severe or distressing. Some sensations remained notably prevalent at 5 years, including tenderness and twinges after SLNB, and tightness and numbness after ALND. Phantom sensations were frequently reported by mastectomy patients. CONCLUSIONS: Prevalence, severity, and level of distress of sensations were lower after SLNB compared with ALND, but some morbidity existed after SLNB. Certain sensations remained highly prevalent in both groups for up to 5 years.

Eighteen sensations after breast cancer surgery: a two-year comparison of sentinel lymph node biopsy and axillary lymph node dissection.

PURPOSE/OBJECTIVES: To evaluate the prevalence, severity, and level of distress of 18 sensations at baseline (3-15 days) and 24 months after breast cancer surgery and to compare sensations after sentinel lymph node biopsy (SLNB) with those after SLNB plus immediate or delayed axillary lymph node dissection (ALND). DESIGN: Prospective, descriptive. SETTING: Evelyn H. Lauder Ambulatory Breast Center at Memorial Sloan-Kettering Cancer Center in New York, NY. SAMPLE: 294 women with breast cancer; 214 had undergone breast conserving therapy, and 80 had undergone total mastectomy; 197 had had SLNB, and 97 had had SLNB and ALND. METHODS: Patients completed the Breast Sensation Assessment Scale (BSAS) at baseline and 3, 6, 12, and 24 months after surgery. MAIN RESEARCH VARIABLES: Prevalence, severity, and level of distress of sensations in patients who had undergone breast cancer surgery. FINDINGS: Sensations were less prevalent, severe, and distressing in patients undergoing SLNB than those undergoing ALND. This difference appeared to be limited to those undergoing breast conserving therapy. Most sensations after SLNB and ALND, even if prevalent, were not very severe or distressing. Some sensations persisted as long as two years. These included tenderness after SLNB and numbness after ALND. Patients often reported phantom sensations after total mastectomy. CONCLUSIONS: Overall, prevalence, severity, and level of distress were lower after SLNB compared to ALND, but some morbidity existed after SLNB. Certain sensations remained prevalent in both groups for as long as 24 months. IMPLICATIONS FOR NURSING: Nurses can use information from this study to provide more accurate education and support to patients.

Sensory morbidity after sentinel lymph node biopsy and axillary dissection: a prospective study of 233 women.

BACKGROUND: We prospectively compared the sensory morbidity and lymphedema experienced after sentinel node biopsy (SLNB) and axillary dissection (ALND) over a 12-month period by using a validated instrument. METHODS: Patients undergoing breast-conserving therapy completed the Breast Sensation Assessment Scale (BSAS) at baseline and 3, 6, and 12 months after surgery. Repeated-measures analysis of variance was used to compare ALND and SLNB over the 12-month period. Upper- and lower-arm circumference measurements at baseline and 12 months were used to assess lymphedema. RESULTS: SLNB was associated with substantial sensory morbidity, although significantly less than ALND, over time on all four subscales and the summary score. A statistically significant improvement in sensory morbidity occurred for both groups in the first 3 months, with no further change thereafter. For both types of axillary surgery, younger patients had significantly higher BSAS scores than older patients. There was no significant difference in arm circumference between patients with SLNB and ALND at 12 months. CONCLUSIONS: Among women undergoing breast-conserving therapy, SLNB has significant sensory morbidity, although approximately half that of ALND. Sensory morbidity improves in the first 3 months after surgery, but patients continue to report sensory morbidity at 1 year. Longitudinal follow-up is required to further assess lymphedema.

Eighteen sensations after breast cancer surgery: a comparison of sentinel lymph node biopsy and axillary lymph node dissection.

PURPOSE/OBJECTIVES: To evaluate prevalence, severity, and level of distress of 18 sensations at 3-15 days (baseline), 3 months, and 6 months after breast cancer surgery; to compare sentinel lymph node biopsy (SLNB) to SLNB with immediate or delayed axillary lymph node dissection; to evaluate the Breast Sensation Assessment Scale(c) (BSAS(c)) for reliability and validity. DESIGN: Prospective, descriptive. SETTING: Evelyn H. Lauder Ambulatory Breast Center at Memorial Sloan-Kettering Cancer Center in New York City. SAMPLE: 283 women with breast cancer; 187 had SLNB, and 96 had SLNB and axillary lymph node dissection. METHODS: Patients completed the BSAS(c) at baseline, three months, and six months after surgery. MAIN RESEARCH VARIABLES: Prevalence, severity, and level of distress of sensations in patients who had breast cancer surgery. FINDINGS: Sensations were less prevalent, severe, and distressing following SLNB compared with axillary lymph node dissection at all three time points. Tenderness and soreness remained highly prevalent following SLNB at the three time points. Tenderness, soreness, tightness, and numbness were among the most severe and distressing symptoms in both groups. The BSAS(c) demonstrated good reliability and validity. CONCLUSIONS: Overall prevalence, severity, and level of distress were lower following SLNB compared with axillary lymph node dissection at baseline, three months, and six months after surgery. Certain sensations remained prevalent, severe, and distressing in both groups. The BSAS(c) is a reliable and valid instrument. IMPLICATIONS FOR NURSING: Nurses should be familiar with prevalent sensations patients experience after SLNB and axillary lymph node dissection so they can provide education and support.