Nurse-based management helpful in older women with breast cancer

Case management by nurses appears to lead to particularly apposite care of older women with breast cancer, researchers report in the September issue of the Journal of the American Geriatric Society.

As lead investigator, Dr. James S. Goodwin told Reuters Health, “this study, along with other recent studies, makes a strong argument for the routine use of nurse case-managers in older patients with complex medical illnesses.”Dr. Goodwin of the University of Texas Medical Branch, Galveston, and colleagues note that one way of improving access and coordination of care, particularly in older patients with cancer, is through “nurse-case management services.”To determine if this approach might lead to an improvement in medical care in community-living women, 65 years of age or older, with breast cancer, the researchers prospectively studied 335 such women. A total of 169 were randomized to nurse-case management.This intervention involved a variety of services including patient contact through home visits, hospital visits and telephone calls, as well as being present at physician appointments. In the year after diagnosis of breast cancer, the nurse case managers made a total of 4049 individual contacts with these patients.In the first 6 months after diagnosis, more women in the intervention group (28.6%) received breast conserving surgery than did controls (18.7%). Of these, 73.8% of the intervention group received adjuvant radiation and 71.4% underwent axillary dissection. In controls, corresponding proportions were 44.8% for both procedures.Overall, more women in the intervention group received breast reconstruction surgery (9.3% versus 2.6%) and radiation therapy (36.0% versus 19.0%). Furthermore, those with advanced cancer were more likely to receive chemotherapy (72.7% versus 30.0%).In addition, 2 months after surgery, a higher proportion of women in the intervention group had normal arm function and they were also more likely to say that they had had a “real” choice in their treatment.Given these findings, the researchers suggest that “nurse-case management might be expected to have a beneficial effect on breast cancer mortality for older women.”(Source: J Am Geriatr Soc 2003;51:1252-1259: Reuters Health: October 6, 2003: Oncolink)