Showing papers by "Alessandro Liberati published in 1993"

Breast cancer surgery in 30 Italian general hospitals

Abstract: The utilization of limited surgery in patients with breast cancer operated between September 1986 and July 1988 was assessed using information collected within a cohort subsequently enrolled in a randomized clinical trial testing the efficacy of post-surgical follow up. Overall 30% had limited surgery, 61% had other more radical procedures and 9% are still undergoing an unnecessary Halsted mastectomy. Several factors were related to the lower likelihood of getting a conservative procedure: geographic distribution, age, level of education, quadrant and nodal state. The paper discusses the implications of these findings in view of the otherwise growing consensus that more radical surgery should be abandoned.

Geographic variability in the appropriateness of surgical treatment of breast carcinoma

Abstract: To assess appropriateness of surgical care delivered to breast cancer patients in Italy and quantify the use of unnecessary radical procedures, a retrospective charts review of patients treated in 1988-1989 was conducted. Information about hospital characteristics was collected directly from administrative departments as a part of a national survey. A series of 1724 consecutive patients (median age 61 years; range 17-89) treated in 63 hospitals selected from within 8 regions, with newly diagnosed operable breast carcinoma was evaluated. Overall, 541 (38%) patients had inappropriate surgery with more than two thirds of it being accounted for by the use of unnecessary mutilating Halsted mastectomy. About one-fourth of patients with stage I-II disease undergone mastectomy according Halsted technique and conservative surgery in patients with small tumors (i.e. tumor size < = 2 cm) was under utilized. Substantial geographic variations emerged in the overall rates of inappropriateness (range 12-48%) which were not substantially affected by allowance for imbalances in patient- and hospital-related variables. Despite the important contribution given by Italian clinical researchers to the demonstration that less radical surgery can be as good as more radical procedures, still a substantial proportion of breast cancer patients are treated too aggressively. Besides pointing to the urgent need of interventions aimed at promoting more appropriate surgical care these results suggest that efforts to increase patients' participation into treatment decision and awareness about alternative treatment options are warranted.

Truth Telling: A Cultural or Individual Choice?

Abstract: To the Editor. —Dr Surbone 1 discusses cross-cultural differences in oncologists' "truth telling" when communicating with patients. While the patients described in her article were terminally ill, for the majority of cancer patients the issue of open communication should be addressed well before the terminal stage. In earlier stages full disclosure allows not only for discussion of diagnosis and prognosis but, often, for patient involvement in important decision making. For example, as Surbone points out, patients with early-stage breast cancer are obvious candidates for involvement in decision making since breast-conserving and radical surgeries appear to have equivalent outcomes. Indeed, when given a choice between surgeries, women are willing and able to decide and are almost always satisfied with the outcomes of their choice. 2 Evidence does not support fears that being given a choice is detrimental to patients. 3 In countries such as Italy, where these fears are strong, the