[A retrospective analysis of clinic-pathological characteristics and prognostic factor for 137 cases of breast cancer brain metastasis].

OBJECTIVE: To investigate the clinicopathological characteristics and prognosis in breast cancer with brain metastasis (BCBM). METHODS: The clinical data of 137 BCBM from June 2002 to June 2008 was reviewed and analyzed. Their molecular subtypes were categorized based on detection of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2) expression. The focal area included 35 cases of triple-negative breast cancer (TNBC), 38 cases of HR (ER and PR) (-)/HER-2(+), 40 cases of HR(+)/HER-2(-), 24 cases of HR(+)/HER-2(+). The clinical characteristics and the outcome in patients with influence were analyzed. RESULTS: In 137 BCBM, the median overal survival after brain metastasis was 6.5 month. The median survivals of TNBC, HR(-)/HER-2(+), HR(+)/HER-2(-) and HR(+)/HER-2(+) were 5.0, 5.5, 10.0 and 9.5 months, respectively. The median survivals after brain metastasis of the breast cancer patients who received the combination therapy of whole brain radiation therapy (WBRT) and neurosurgery and/or stereotactic radiosurgery, received WBRT but not combination therapy and didn't receive WBRT were 15.0, 9.5 and 4.0 months, respectively. In univariate survival analysis, substyle, number of brain metastasis, brain metastasis as initial recurrence or not, brain-only metastases or not, the combination therapy status after brain metastasis were obviously correlated with the prognosis (χ(2) = 6.891 to 29.414, P < 0.05). Substyle (RR = 1.234, 95%CI: 1.057 to 1.440) and the combination therapy status after brain metastasis (RR = 1.838, 95%CI: 1.389 to 2.431) were independent prognostic factor in multivariable analysis (P < 0.05). CONCLUSIONS: TNBC confers a high risk of death after brain metastases. Systemic treatment via combined modalities are helpful for breast cancer patients, even after the detection of brain metastases.

[Nursing experience: discharge planning for a disabled elderly patient].

This case study describes the comprehensive and continuous care provided to an elderly patient whose self-care ability had been lost in a traffic accident. During the nursing period, from March 4th 2004 to May 18th 2004, we utilized the literature on the health problems of the elderly, concepts of discharge planning, and a comprehensive nursing assessment to confirm that the main nursing issues were clearance of a blocked airway, and impaired mobility. We also helped caregivers to cope with the problems of role strain. During the nursing process, we placed particular emphasis on management and preparation for care after discharge, the training of a maid, and psychological support for the family. The experience enabled surgical ward nurses who were already used to fast discharges of patients to gain a better understanding of discharge planning in complex cases involving the disabled elderly.