title: Effect of nurse case management on the treatment of older women with breast cancer.
abstract: OBJECTIVE
  To evaluate the effect of nurse case management on the treatment of older women with breast cancer.
  
  
  METHODS
  Randomized prospective trial.
  
  
  METHODS
  Sixty surgeons practicing at 13 community and two public hospitals in southeast Texas.
  
  
  METHODS
  Three hundred thirty-five women (166 control and 169 intervention) aged 65 and older newly diagnosed with breast cancer.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Nurse case management results in more appropriate management of older women with breast cancer.
authors.affiliation: Department of Internal Medicine, School of Medicine, The University of Texas Medical Branch, Galveston, Texas 77555, USA. jsgoodwi@utmb.edu
authors.forename: James S
authors.initials: JS
authors.lastname: Goodwin
authors.forename: Shiva
authors.initials: S
authors.lastname: Satish
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Anderson
authors.forename: Ann B
authors.initials: AB
authors.lastname: Nattinger
authors.forename: Jean L
authors.initials: JL
authors.lastname: Freeman
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000451:nursing / Q000523:psychology / Q000601:surgery / Q000628:therapy*; D019090:Case Management; D003627:Data Interpretation, Statistical; D005260:Female; D015577:Geriatric Assessment; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D017060:Patient Satisfaction; D010819:Physician's Role; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012944:Social Support; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome