Postdischarge pain, nausea and patient satisfaction after diagnostic and breast‐conserving ambulatory surgery for breast cancer: A cross‐sectional study

Stjernberg, Mi; Schlichting, Ellen; Rustøen, Tone; Valeberg, Berit Taraldsen; Småstuen, Milada Cvancarova; Ræder, Johan

doi:10.1111/aas.14015

Cited by 7 publications

(5 citation statements)

References 38 publications

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“…Patients expressed very high degrees (> 95%) of satisfaction with the information and timing of surgery, chemotherapy, and radiotherapy. This high level of patient satisfaction is consistent with what has recently been measured in other developed countries [ 9 , 10 ].…”

Section: Discussionsupporting

confidence: 91%

French national survey on breast cancer care: caregiver and patient views

Rousset-Jablonski,

Lortal,

Lantheaume

et al. 2024

Breast Cancer

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Purpose To improve the quality of care for patients with breast cancer, an analysis of the health-care pathway, considering feedback from both health-care practitioners (HCPs) and patients, is needed. Methods Between 2020 and 2022, we conducted a survey at French breast cancer centers and analyzed information from questionnaires completed by HCPs and patients. We collected information on center organization, diagnostic processes, treatment decisions and modalities, supportive care, patient advocacy groups, and work issues. Results Twenty-three breast cancer centers were included and questionnaires completed by 247 HCPs and 249 patients were analyzed. The centers closely followed the legal French framework for cancer treatments, which includes formal diagnostic announcements, multidisciplinary tumor boards, personalized treatment summaries, and supportive care access. HCPs and patients were satisfied with the time to diagnosis (≤ 2 weeks as evaluated by 75% of patients), time to surgery (mean 61 days), time between surgery and chemotherapy (mean 47 days), and time between surgery and radiotherapy (mean 81 days). Fertility preservation counseling for women under 40 years of age was systematically offered by 67% of the HCPs. The majority (67%) of the patients indicated that they had received a personalized treatment summary; the topics discussed included treatments (92%), tumor characteristics (84%), care pathways (79%), supportive care (52%), and breast reconstruction (33%). Among HCPs, 44% stated that reconstructive surgery was offered to all eligible patients and 57% and 45% indicated coordination between centers and primary care physicians for adverse effects management and access to supportive care should be improved, for chemotherapy and radiotherapy, respectively. Regarding patient advocacy groups, 34% of HCPs did not know whether patients had contact and only 23% of patients declared that they had such contact. For one-third of working patients, work issues were not discussed. Twenty-eight percent of patients claimed that they had faced difficulties for supportive care access. Among HCPs, 13% stated that a formal personalized survivorship treatment program was administered to almost all patients and 37% almost never introduced the program to their patients. Compliance to oral treatments was considered very good for 75–100% of patients by 62% of HCPs. Conclusions This study provides an updated analysis of breast cancer care pathways in France. Overall, the initial processes of diagnosis, announcement, and treatment were swift and were in agreement with the best care standards. No barriers to accessing care were identified. Based on the study findings, we proposed several strategies to improve the quality of care for patients in supportive care, coordination with primary care physicians, reconstructive surgery, and fertility preservation access.

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Section: Discussionsupporting

confidence: 91%

French national survey on breast cancer care: caregiver and patient views

Rousset-Jablonski,

Lortal,

Lantheaume

et al. 2024

Breast Cancer

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“…Use of regional anesthesia has good evidence to reduce pain scores, nausea and vomiting rates, and PACU length of stay [ 76 ]. High pain scores after breast surgery have been associated with higher rates of post-discharge nausea and vomiting that Stjernberg et al [ 77 ] thought was due to higher opioid consumption.…”

Section: Complex Patientsmentioning

confidence: 99%

Safety considerations with the current ambulatory trends: more complicated procedures and more complicated patients

Young

Osman

Shapiro³

2023

Korean J Anesthesiol

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In the last quarter of a century, the backdrop of appropriate ambulatory and office-based surgeries has changed dramatically. Procedures that were traditionally were done in hospitals or patients being admitted after surgery are migrating to the outpatient setting and being discharged on the same day, respectively, at a remarkable rate. In the face of this exponential growth, anesthesiologists are constantly being challenged to maintain patient safety by understanding the appropriate patient selection, procedure, and surgical location. Recently published literature supports the trend of higher more medically complex patients and more complicated procedures shifting towards the outpatient arena. Several reasons that may account for this include cost incentives, advancement in anesthesia techniques, enhanced recovery after surgery protocols, and increased patient satisfaction. Anesthesiologists must understand that there is a lack of standardized state regulations regarding ambulatory surgery centers and office-based surgery sites.Current and recently graduated anesthesiologists, should be aware of the safety concerns related to the various non-hospital-based locations, the sustained growth and demand for anesthesia in the office, and the expansion of mobile anesthesia practices around the US in order to keep up and practice safely with the professional trends. Continuing procedural ambulatory shifts will require ongoing outcomes research, likely prospective in nature, on these novel outpatient procedures, in order to develop risk stratification and prediction models for the selection of the proper patient, procedure, and surgery location.

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“…The regular use of preoperative painkillers will be an independent risk factor, especially if opioids are used preoperatively [19 ▪ ]. In general, young patients tend to have more pain than elderly [20 ▪ ], and females more than men. Psychosocial aspects may be important, patients with a history of anxiety or depression are more prone to pain, as are a catastrophizing attitude [3 ▪ ,18,21 ▪ ,22].…”

Section: Individual Preoperative Risk Of Postoperative Painmentioning

confidence: 99%

“…PONV may also be a problem with opioids, but are dose and duration dependant and subject to effective prophylactic measures [17 ▪ ]. It seems like use of short-acting perioperative remifentanil together with NSAID and glucocorticoid and a minor dose of bridging fentanyl by the end of the procedure, renders the patients well protected from hyperalgesia [20 ▪ ,47]. Then, opioids should be used only as needed in the postoperative period, primarily by titration of short-acting opioid during the first hours [48 ▪ ].…”

Section: The Opioidsmentioning

confidence: 99%

Pain treatment and prophylaxis on pain

Ræder¹

2022

Current Opinion in Anaesthesiology

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Purpose of reviewAlso in ambulatory surgery, there will usually be a need for analgesic medication to deal with postoperative pain. Even so, a significant proportion of ambulatory surgery patients have unacceptable postoperative pain, and there is a need for better education in how to provide proper prophylaxis and treatment.Recent findingsPostoperative pain should be addressed both pre, intra- and postoperatively. The management should be with a multimodal nonopioid-based procedure specific guideline for the routine cases. In 10–20% of cases, there will be a need to adjust and supplement the basic guideline with extra analgesic measures. This may be because there are contraindications for a drug in the guideline, the procedure is more extensive than usual or the patient has extra risk factors for strong postoperative pain. Opioids should only be used when needed on top of multimodal nonopioid prophylaxis. Opioids should be with nondepot formulations, titrated to effect in the postoperative care unit and eventually continued only when needed for a few days at maximum.SummaryMultimodal analgesia should start pre or per-operatively and include paracetamol, nonsteroidal anti-inflammatory drug (NSAID), dexamethasone (or alternative glucocorticoid) and local anaesthetic wound infiltration, unless contraindicated in the individual case. Paracetamol and NSAID should be continued postoperatively, supplemented with opioid on top as needed. Extra analgesia may be considered when appropriate and needed. First-line options include nerve blocks or interfascial plane blocks and i.v. lidocaine infusion. In addition, gabapentinnoids, dexmedetomidine, ketamine infusion and clonidine may be used, but adverse effects of sedation, dizziness and hypotension must be carefully considered in the ambulatory setting.

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Postdischarge pain, nausea and patient satisfaction after diagnostic and breast‐conserving ambulatory surgery for breast cancer: A cross‐sectional study

Cited by 7 publications

References 38 publications

French national survey on breast cancer care: caregiver and patient views

French national survey on breast cancer care: caregiver and patient views

Safety considerations with the current ambulatory trends: more complicated procedures and more complicated patients

Pain treatment and prophylaxis on pain

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