Regular physical exercise can maximize physical, mental, and social well-being during and after treatment in breast cancer survivors. An exercise program following cancer therapy is facilitated by instilling a positive attitude toward exercise, confidence in conquering barriers, and a supportive social environment. The purpose of this article is to describe the benefits of moderate exercise in breast cancer survivors and propose a comprehensive approach for the cancer care team in maximizing survivor efforts to improve their physical strength and endurance after completion of adjuvant therapy for breast cancer (surgery, chemotherapy, and/or radiation). A moderate exercise program can help most survivors become more physically and mentally fit and energetic. Understanding factors that prompt the initiation of healthy lifestyle choices among breast cancer survivors is critical to encouraging an attitude of healthy living.
A chart audit at one cancer center, of 193 women with breast cancer, was completed to assess whether a complete family history that may indicate genetic predisposition was obtained and if that information led a provider to suggest risk reduction strategies. A risk management tool, which included a pedigree template, was used. Of the 193 charts reviewed, 88.6% had family history information recorded; 41.5% reported three generations of family history. Risk management was undocumented in 21.8% of the charts reviewed and, for those that were reported (78.2%), 7.25% were referred for genetic counseling. These results suggest that a more detailed assessment of hereditary breast cancer risk incorporating three generations of family history and additional types of cancer need to be integrated into medical oncology practice. An algorithm was developed as a guide to improve the process of evaluation and referral for genetic risk assessment.
6121 Background: In 2002, Kansas City Cancer Center (KCCC) performed a quality improvement (QI) project to evaluate how breast cancer patients were being assessed for family history and cancer risk management. A self-administered family history questionnaire was developed to improve the thoroughness of family history collected and education of clinicians was completed to improve the recognition of risk factors based on ASCO guidelines. Methods: Chart audits on 210 women with breast cancer at KCCC, were completed in the second quarter of 2005. All patients were under the age of 65, not undergoing chemotherapy. A risk management tool was developed. Scoring criteria for 2002 was replicated in 2005 as listed in the table . Results: In 2002, 171 pts (89%) had level 1 or 2 family history assessed compared to 207 pts (99%) in 2005, p<0.0001. In 2002, 47% had 3 generations assessed compared to 84% in 2005, p<0.0001. In 2002 and 2005, some risk factor management occurred in both groups, and was equal, 78% and 80% respectively (p=ns). Of those that had risk management 33% had level 1 in 2002 compared to 3% in 2005 (p<0.0001) a 91% reduction in identifying risk without subsequent management. In 2002, 58% had level 2, compared to 71% in 2005 (p=0.02) a 23% improvement in identification & management of risk. In 2002, 9% had level 3 compared to 26% in 2005 (p<0.0001) a 183% improvement in patients with a detailed risk assessment and/or genetic referral. Conclusions: By improving the assessment of family history and education of providers, women with breast cancer are receiving more information to reduce their risk for recurrence and complications. Patients who were identified as high risk for BRCA1 or BRCA2 mutations were referred to either a nurse practitioner or genetic counselor. [Table: see text] No significant financial relationships to disclose.
18556 Background: A demonstration project testing the feasibly of implementing a depression screening work flow algorithm was initiated by the anti-depression committee at one of six ambulatory care sites in the Kansas City Cancer Center (KCCC) system. The object of the study was to develop a process of work flow that would assist in identifying patients with depression and facilitate appropriate interventions by providers. Methods: A flow chart was developed illustrating critical decision-making points in the screening for depression by physicians and nurse practitioners (NP). The population included half radiation therapy and the other half chemotherapy. Patients completed the PHQ-2 a two question prescreen to assess initial symptoms of depression, including feeling depressed, down or hopeless and/ or little interest or pleasure in activities. A positive response to one of these 2 questions prompted the administration of the PHQ-9 a validated depression screening instrument. The PHQ-9 scoring criteria was used to assist the physician and NP with taking the appropriate action such as the initiation of antidepressant therapy and/or referral to mental health provider, follow up for subsequent appointments and/or reassessment. Results: Seventy-one patients were tracked to evaluate the process of recognition and management of depression from April 2004 to January 2005. Of the 71 patients 37% (N = 26) scored positive on at least one question on the two question prescreen. Of the 26 patients scoring positive 27% (N = 7) of these patients had less than 3 follow up visits while 73 % (N = 19) had greater than 3 follow-up visits by the KCCC providers. Of the patients that answered positively to one of the two prescreen questions 69% (N = 18) completed the full PHQ-9 and their scores were recorded. Conclusions: The development of a new model in a community-based oncology practice allows for integrating clinically proven techniques for diagnosing and treating depression. It will allow for the committee to make recommendations for changes in the process before it is implemented on a larger scale at all KCCC outpatient sites. No significant financial relationships to disclose.
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