Cutaneous Metastasis due to Breast Cancer in a Patient with Primary Biliary Cirrhosis: A Case Report.

BACKGROUND: Breast cancer is the most common solid tumor to cause cutaneous metastases. These are incurable and the treatment goal is geared toward local control with surgical excision, radiation, and chemotherapy. However, treatment can be challenging in subjects with end-stage liver disease and a multidisciplinary approach is warranted. CASE REPORT: In this case report, we present a 61-year-old female with primary biliary cirrhosis and human epidermal growth factor-2 (HER-2)-positive breast cancer, who subsequently developed cutaneous metastases. We briefly describe the treatment challenges due to underlying end-stage liver disease, and an exceptional response to trastuzumab and nab-paclitaxel. CONCLUSION: A multidisciplinary approach to local control and attenuated doses of nab-paclitaxel and trastuzumab suggest a durable response to HER-2-positive breast cancer with cutaneous metastasis. Subjects with end-stage liver disease pose unique challenges and toxicities, warranting additional research and drug development for less hepatotoxic antineoplastic agents.

Navigating the Needs of Rural Women with Breast Cancer: A Breast Care Program.

We describe the development and establishment of a breast care program (BCP) with service for rural breast cancer patients. Our program is a comprehensive program serving rural communities in Wisconsin. Our BCP is committed to breast health throughout the continuum from breast cancer risk assessment and prevention, advanced diagnostics, and screening tools to genetic testing and state-of-the-art surgical techniques. To provide the highest level of care, we coordinate a breast care team involving collaboration of multidisciplinary healthcare professionals. Experts from various departments, including radiologists, pathologists, breast surgeons, medical and radiation oncologists, genetic counselors, clinical trial specialists, and our breast care navigator, all work together to provide cutting edge cancer treatment and management. Our distinctive BCP allows patients to see multiple providers without having to make multiple appointments and promotes discussion of treatment recommendations and creation of a personalized treatment plan for each patient by a team of specialists.

Sexual health assessment and counseling: oncology nurses' perceptions, practices, and perceived barriers.

BACKGROUND: Cancer-related sexual dysfunction has a negative impact on patient quality of life. OBJECTIVE: To describe oncology nurses' perceptions, practices, and perceived barriers regarding sexual health assessment and counseling. METHODS: In 2005, a 31-item questionnaire was mailed to 56 oncology nurses employed at 6 regional cancer care centers in northern, central, and western Wisconsin. Questions captured demographic information about the nurses and information about attitudes, perceptions, and practice patterns regarding patient sexual health counseling, and the barriers to discussing sexuality with patients. RESULTS: Nearly 70% of mailed surveys were returned completed. Most of the respondents believed that sexual health concerns were important and that it was appropriate for nurses to discuss patient sexual concerns, but less than one-third of the nurses said they had offered to discuss sexual concerns with patients in the previous 12 months. Few respondents reported feeling adequately knowledgeable about talking to patients about concerns about sexual health, and more than 90% thought that additional training in sexual health counseling would increase their confidence in addressing sexual health issues. LIMITATIONS: Study findings are limited by validity of the survey instrument and issues related to self-report. Sensitivity of the topic may have resulted in selection bias. CONCLUSIONS: Sexual health among patients with cancer was recognized as important, but was discussed infrequently. Additional training may improve the ability of oncology nurses to provide sexual health counseling to patients.

Digital ischemia as a paraneoplastic consequence of squamous cell lung carcinoma.

We report the case of a 40-year-old man who presented with digital ischemia and squamous cell lung carcinoma. Based on review of the literature, to our knowledge this case represents the youngest patient with lung carcinoma associated with digital ischemia and the only one with this type of tumor. The patient's digital ischemia symptoms improved rapidly with systemic chemotherapy; however, he did eventually lose the distal portion of 1 finger to dry gangrene and mummification.