Goodwin James S, Satish Shiva, Anderson Elizabeth T, Nattinger Ann B, Freeman Jean L
Department of Internal Medicine, School of Medicine, The University of Texas Medical Branch, Galveston, Texas 77555, USA.
J Am Geriatr Soc. 2003 Sep;51(9):1252-9. doi: 10.1046/j.1532-5415.2003.51409.x.
To evaluate the effect of nurse case management on the treatment of older women with breast cancer.
Randomized prospective trial.
Sixty surgeons practicing at 13 community and two public hospitals in southeast Texas.
Three hundred thirty-five women (166 control and 169 intervention) aged 65 and older newly diagnosed with breast cancer.
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.
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.
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.
Nurse case management results in more appropriate management of older women with breast cancer.
评估护士个案管理对老年乳腺癌女性治疗的效果。
随机前瞻性试验。
得克萨斯州东南部13家社区医院和2家公立医院的60名外科医生。
335名65岁及以上新诊断为乳腺癌的女性（166名对照组和169名干预组）。
随机分配到干预组的女性在乳腺癌诊断后接受护士个案管理服务12个月。
主要结局是诊断后前6个月接受的癌症特异性治疗的类型和使用情况。次要结局是诊断后2个月时患者的满意度和患侧手臂功能。
干预组中更多女性接受了保乳手术（28.6%对18.7%；P=0.031）和放射治疗（36.0%对19.0%；P=0.003）。在接受保乳手术的女性中，个案管理组接受辅助放疗（78.3%对44.8%；P=0.001）和腋窝淋巴结清扫（71.4%对44.8%；P=0.057）的比例更高。个案管理组的女性也更有可能接受更多的乳房重建手术（9.3%对2.6%，P=0.054），且个案管理组中患有晚期癌症的女性更有可能接受化疗（72.7%对30.0%，P=0.057）。手术后2个月，个案管理组中手臂功能正常的女性比例更高（93%对84%；P=0.037），且更有可能表示她们在治疗中有真正的选择权（82.2%对
