Effect of nurse case management on the treatment of older women with breast cancer.

OBJECTIVES

To evaluate the effect of nurse case management on the treatment of older women with breast cancer.

DESIGN

Randomized prospective trial.

SETTING

Sixty surgeons practicing at 13 community and two public hospitals in southeast Texas.

PARTICIPANTS

Three hundred thirty-five women (166 control and 169 intervention) aged 65 and older newly diagnosed with breast cancer.

INTERVENTION

Women seeing surgeons randomized to the intervention group received the services of a nurse case manager for 12 months after the diagnosis of breast cancer.

MEASUREMENTS

The primary outcome was the type and use of cancer-specific therapies received in the first 6 months after diagnosis. Secondary outcomes were patient satisfaction and arm function on the affected side 2 months after diagnosis.

RESULTS

More women in the intervention group received breast-conserving surgery (28.6% vs 18.7%; P=.031) and radiation therapy (36.0% vs 19.0%; P=.003). Of women undergoing breast-conserving surgery, greater percentages in the case management group received adjuvant radiation (78.3% vs 44.8%; P=.001) and axillary dissection (71.4% vs 44.8%; P=.057). Women in the case management group were also more likely to receive more breast reconstruction surgery (9.3% vs 2.6%, P=.054), and women in the case management group with advanced cancer were more likely to receive chemotherapy (72.7% vs 30.0%, P=.057). Two months after surgery, higher percentages of women in the case manager group had normal arm function (93% vs 84%; P=.037) and were more likely to state that they had a real choice in their treatment (82.2% vs 69.9%, P=.020). Women with indicators of poor social support were more likely to benefit from nurse case management.

CONCLUSION

Nurse case management results in more appropriate management of older women with breast cancer.