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The Application of Whole-Process Case Management in Patients with Triple-Negative Breast Cancer

The Application of Whole-Process Case Management in Patients with Triple-Negative Breast Cancer Hindawi Journal of Oncology Volume 2022, Article ID 1794288, 6 pages https://doi.org/10.1155/2022/1794288 Research Article The Application of Whole-Process Case Management in Patients with Triple-Negative Breast Cancer 1 2 2 2 2 2 2 Yunyan Zhao, Ran Zhu, Jie Bai, Jie Li, Xue Jia, Peng Wang, and Lijun Jin Department of Tumour Medicine Ward, Cangzhou Central Hospital, Cangzhou, China Department of yroid and Breast III, Cangzhou Central Hospital, Cangzhou, China Correspondence should be addressed to Lijun Jin; jinjishun434419038@163.com Received 21 December 2021; Revised 16 January 2022; Accepted 20 January 2022; Published 16 March 2022 Academic Editor: Wei long Zhong Copyright © 2022 Yunyan Zhao et al. ,is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To explore the application of professional whole-process case management during nursing in patients with triple- negative breast cancer. Methods. ,is study recruited 60 patients with triple-negative breast cancer who were diagnosed and treated at Department of Breast Surgery in our hospital assessed for eligibility between June 2018 and June 2020, and we assigned them at a ratio of 1 : 1 via the random number table method to receive either general nursing (control group) or professional whole-process case management plus general nursing (observation group). We analyzed and evaluated the hospitalization, the indwelling time of drainage tube, complications, recovery, quality of life, posttraumatic growth, and nursing satisfaction between these two groups at registration, discharge, and the sixth month after surgery, respectively. Results. Professional whole-process case management achieved a shorter duration of drainage tube placement and hospitalization and a lower incidence of post- operative complications versus general nursing (P< 0.05). Moreover, the observation group had got better recovery (P< 0.05) and a better quality of life at discharge and 6 months after surgery (P< 0.05). Professional whole-process case management obtained higher scores of posttraumatic growth and higher nursing satisfaction versus general nursing (P< 0.05). Conclusion. Whole- process case management promotes the postoperative recovery of patients with triple-negative breast cancer and shortens the duration of drainage tube indwelling and hospitalization, which lowers the incidence of postoperative complications, improves their quality of life, and enhances nursing satisfaction. characteristics, formulation of an personalized nursing plan 1. Introduction and follow-up visits, and high-quality nursing services [5]. Breast cancer is the most common cancer compromising the Whole-process case management gives full play to the quality of life and psychological health of women [1]. Its positive effect of personalized care in improving health treatment efficiency presents obvious enrichments as the management knowledge and trust and provides full atten- medical techniques advance with years [2]. However, pa- tion and follow-up support to patients’ health management tients are required to receive adjuvant chemotherapy despite knowledge and trust issues. It is a case-centered approach in receiving breast cancer surgery with curative intent and which case managers are responsible for coordinating and usually experience postoperative complications and side integrating the opinions of various professionals, making full effects from chemotherapy, which compromises their and effective use of medical resources, and providing dy- quality of life [3]. ,us, an urgent need exists to further namic, continuous, individualized, and comprehensive explore the improvement of quality of life, psychological professional guidance and consultation to patients to ensure health, and nursing satisfaction. Professional whole-process complete treatment and care for each case. Case manage- case management has been proposed in recent years with the ment is broadly used in diabetes, coronary heart disease, advances of nursing [4]. Whole-process case management, mental illness, and oncology. Research has indicated [6] that encompasses the integration of patients’ baseline the whole-process case management considerably enhances 2 Journal of Oncology Table 1: Comparison of general materials. the quality of life and is of great clinical significance for patients with breast cancer. Accordingly, this study was Observation Control t/χ2 P intended to explore the application of whole-process case group group management among 60 patients with triple-negative breast Age(years) 47.30± 8.26 46.43± 7.89 0.415 0.680 cancer. TNM stage Stage I 6 7 2. Materials and Methods Stage II 17 18 0.439 0.803 Stage III 7 5 2.1. General Materials. ,is study consisted of 60 patients Education level with triple-negative breast cancer who were diagnosed and Primary school 6 5 treated at the Department of Breast Surgery in our hospital Junior school 13 11 0.618 0.734 between June 2018 and June 2020, and we assigned them to High school or 11 14 an observation group (n � 30) and a control group (n � 30) above by random number table. ,e protocol of this study was ethically approved by the Ethics Committee of Cangzhou and adhered to the plan to complete the treatment course Central Hospital (approval no. 2017-12/341). ,e baseline according to the medical prescription. ,e nurses were also features of the two groups were similar (P> 0.05) (Table 1). required to grasp the type, degree, and risk factors of adverse reactions in each patient and deliver timely and appropriate 2.2.SelectionCriteria. Inclusion criteria [7]: (1) patients who risk prevention and adverse reaction control interventions. were diagnosed with triple-negative breast cancer. (2) Pa- ,e patients were instructed to actively carry out self-care tients who were in I stage and II stage as per American Joint activities to improve their ability to cope with the prevention Committee on Cancer (AJCC). (3) Patients with grade I or II and control of adverse reactions to radiotherapy. (3) During preoperative evaluation as per American Society of Anes- the hospitalization, nursing rounds were strengthened to thesiologists (ASA). (4) Patients who received modified closely monitor the patients’ adverse reactions after radio- radical mastectomy. (5) Patients with self-care ability, aged therapy, to maintain dynamic and continuous observation ≥18 years old, and with normal communication ability. (6) for those with milder reactions, to provide feedback to the Patients who received intravenous chemotherapy with attending physician for those with more severe reactions and anthracycline and paclitaxel after surgery. (7) Patients who to cooperate with symptomatic management care. (4) had completed and signed the informed consent form. Popularized postoperative nursing. ,e patients were given Exclusion criteria: (1) Patients with severe organ dysfunc- breast cancer rehabilitation guidelines, with verbal in- tion. (2) Patients with severe mental illness or disorders of structions on diet and physical rehabilitation training, consciousness. (3) Patients with distant organ metastasis. prevention and control of adverse reactions, daily life, and nursing care. ,ey were also supervised to record daily diet and exercise, adverse reactions, self-care, and daily living 2.3. Methods conditions, and the responsible nurses provided targeted 2.3.1. e Control Group. ,e control group received gen- individualized nursing interventions based on the issues in eral nursing during hospital stay. First, we provided patients the radiotherapy log. (5) Performed psychological nursing. with a complete professional examination and monitored ,e nursing staff conducted semistructured interviews and their conditions. Next, we took required measures for open-ended questions with the patients, without guidance complications and modified nursing plan with the changes and suggestion, and observed the changes in emotions and in their conditions. In addition, we followed the doctor’s expressions of the patients during communication to timely advice to offer corresponding perioperative nursing, drug identify their problems. In addition, the nurses helped pa- nursing, and diet management. tients to correctly understand radical breast cancer surgery and postoperative rehabilitation, provided information support and health education. ,e nurses provided sup- 2.3.2. e Observation Group. ,e observation group was portive emotional guidance, targeted psychological care and provided with whole-process case management during the emotional and counseling interventions, formulated indi- hospital stay. Specific measures were as follows: (1) a pro- vidualized strategies according to the patient’s condition, fessional case management team was built up. ,e head paid attention to the patient’s psychological state, and used nurse was the team leader, and nurses were organized to “psychological sand tray therapy” to help the patient release receive training of the whole process of professional case repressed emotions and cathartic methods to eliminate the management, and those who passed the exam were eligible patient’s negative emotions. to perform the case management employed in the present study. (2) ,e nurses issued case follow-up management record sheets to the patients, mastered the case radiotherapy 2.4. Observation Indicators plans and timing, dynamically observed the patients’ emotion, provided causal psychological counseling to pa- (1) We evaluated the quality of life of subjects at reg- istration, discharge, and six months after surgery as tients with excessive anxiety, fear, and depression, en- couraged the patients to overcome obstacles and difficulties, per the Chinese version of functional assessment of Journal of Oncology 3 cancer therapy-breast (FACT-B) that was composed 2.5. Statistical Analysis. In this study, SPSS25.0 statistical of the functional assessment of cancer therapy software was applied for data analyses. ,e measurement (FACT) scale used for the assessment of the quality data were expressed as mean± standard error and were of life and the breast cancer scale (BCS). FACT was tested by independent paired t-test or analysis of variance. composed of physical condition (7 items), social/ n(%) was used to represent the count data that were tested by family conditions (7 items), mental state (6 items), χ2 test. Differences were considered statistically significant at and functional status (7 items), and the BCS was P< 0.05. composed of 9 items, with five grades each item, ranging from 0 to 4 points. A higher score meant a 3. Results better quality of life. 3.1. Comparison of Hospital Stay and Indwelling Time of (2) We estimated the mental state via self-rating anxiety Drainage Tube. Professional whole-process case manage- scale (SAS) and self-rating depression scale (SDS) at ment achieved a shorter duration of drainage tube place- discharge. SAS was composed of 20 projects, and the ment and hospitalization and a lower incidence of integer of the summation of all items × 1.25 was postoperative complications versus general nursing defined as standard. A higher score meant more (P< 0.05) (Table 2). severe anxiety. It was defined as normal if the scores were under 50 points, mild if 50 to 60 points, moderate if 61 to 70 points, and severe if more than 3.2. Comparison of Quality of Life Scores. No statistically 70 points. SDS was composed of 20 items, and its significant differences were found in the quality of life be- calculation was the same as SAS, and a higher score tween the two groups before treatment (P> 0.05). ,e ob- meant that symptoms were more severe. It was servation group had a better quality of life at discharge and normal if the scores were under 53 points, mild if 6 months after surgery (P< 0.05) (Table 3). 53–62 points, moderate if 63–72 points, and severe if more than 72 points. 3.3. Comparison of Mental State and Nursing at Discharge. (3) We assessed the nursing satisfaction at discharge ,e mental state of the observation group was superior to using a self-made questionnaire (a total score of 100 that of the control group (P< 0.05). Patients in the obser- points). vation group were more satisfied with the nursing than those in the control group (P< 0.05). (Table 4). (4) We assessed the posttraumatic growth with the use of the posttraumatic growth inventory (PTGI) at registration, discharge, and six months after surgery. 3.4. Comparison of the Shoulder Joint Recovery of the Affected ,is scale designed by Tedsky in 1996 was composed Limb. Professional whole-process case management of 21 items from five aspects of interpersonal rela- showed more significant improvements in the shoulder joint tionships, potentials, personal strength, mental recovery of the affected limb versus general nursing changes, and appreciation of life. In addition, Likert (P< 0.05) (Table 5). was used to scale. ,e score was proportional to posttraumatic growth. 3.5. Comparison of Posttraumatic Growth. When comparing (5) We calculated the complication rate six months after the posttraumatic growth scores between the two groups, we surgery. Common complications included postop- found that there were no significant between the two groups erative bleeding, postoperative incision infection, at registration, while the observation group was superior to axillary lymphatic leakage, and loss of appetite. the control group at discharge and six months after surgery Complication rate � (complication numbers/total) × (P< 0.05) (Table 6). 100%. (6) We observed the recovery of the affected limb and 3.6. Comparison of the Incidence of Complications. In the complications and evaluated the efficacy based on observation group, there were 2 cases with postoperative the postoperative shoulder joint range of motion bleeding, 1 case with postoperative infection, 2 cases with (ROM) [8] at discharge and six months after axillary lymphatic leakage, and 2 cases with loss of appetite. surgery. ,e standard of ROM was that the In the control group, there were 5 cases with postoperative ° ° shoulder joint bent forward 0 –180 , stretched bleeding, 3 cases with postoperative infection, 4 cases with ° ° ° ° backward 0 –50 , stretched outside 0 –180 , and axillary lymphatic leakage, and 6 cases with loss of appetite. ° ° turned 0 –90 . It was good if the shoulder joint bent ,e observation group showed a lower incidence of post- ° ° forward 0–160 , stretched backward 0–40 , operative complications than the control group (P< 0.05) ° ° stretched outside 0–160 , and rotated 0–60 inside (Table 7). and outside, respectively. It was poor if the shoulder joint bent forward 0–140 , stretched 4. Discussion ° ° backward 0–30 , stretched outside 0–140 , and rotated 0–30 inside and outside, respectively. Both Breast cancer is a malignancy that threatens the health of groups were followed up for 6 months. women [9]. Treatment shows an individual and 4 Journal of Oncology Table 2: Comparison of hospital stays and indwelling time of drainage tube. n Indwelling time of drainage tube (d) Hospital stays (d) Observation group 30 11.13± 5.17 11.66± 3.92 Control group 30 14.20± 4.31 14.53± 4.10 t 2.495 2.764 P 0.020 0.010 Table 3: Comparison of quality-of-life scores. n Registration Discharge Six months after surgery Observation group 30 86.83± 7.14 103.16± 7.61 110.83± 6.15 Control group 30 84.96± 4.31 91.30± 6.32 93.96± 5.42 t 0.937 6.567 11.251 P 0.350 <0.001 <0.001 Table 4: Comparison of mental state and nursing at discharge. n SAS SDS Nursing satisfaction Observation group 30 62.50± 5.85 62.16± 5.50 105.13± 5.66 Control group 30 53.63± 7.01 53.30± 7.40 82.40± 7.20 t 5.316 5.264 13.578 P <0.001 <0.001 <0.001 Table 5: Comparison of the shoulder joint recovery of the affected limb. At discharge Six months after surgery Excellent Good Poor Excellent Good Poor Observation group 30 17 10 3 25 5 0 Control group 30 5 15 10 6 18 6 χ2 11.315 24.993 P 0.003 <0.001 Table 6: Comparison of posttraumatic growth. n Registration Discharge Six months after surgery Observation group 30 47.43± 6.70 69.10± 5.79 88.76± 6.45 Control group 30 45.96± 6.54 57.63± 5.98 72.96± 6.44 t 0.857 7.541 9.492 P 0.395 <0.001 <0.001 Table 7: Comparison of the incidence of complications. n Postoperative bleeding Postoperative infection Axillary lymphatic leakage Loss of appetite Incidence Observation group 30 2 1 2 2 7(23.33) Control group 30 5 3 4 6 18(60.00) χ2 8.297 P 0.004 multidisciplinary pattern with the ongoing development of and mental state benefits the quality of life. It has been medical management, which contributes to the enrichments reported that the whole-process case management offers of efficacy [10]. Mental evaluation and targeted counseling patients good family and social support, thereby promoting are used to alleviate the patients’ excessive depression and their mental health and quality of life [13]. ,e present study anxiety, for a better treatment result [11]. revealed a better quality of life in patients given case Quality of life indirectly reflects the efficacy and is also management versus general nursing, which may be attrib- one of the essential factors indicating the alleviation of uted to the constant evaluation of the patients’ mental state symptoms and recovery [12]. ,e improvement of physical and the prompt resolution of potential risk during recovery. Journal of Oncology 5 [3] C. Vila, C. Reñones, T. Ferro et al., “Advanced breast cancer In addition, case managers had positive interactions between clinical nursing curriculum: review and recommendations,” the case managers and the patients achieved robust social Clinical and Translational Oncology, vol. 19, no. 2, pp. 251– support that promoted their psychological recovery. 260, 2017. Moreover, the relevant health group or lectures organized by [4] B. Marzbani, J. Nazari, F. Najafi et al., “Dietary patterns, the case managers help the patients learn about the methods nutrition, and risk of breast cancer: a case-control study in the of disease management and receive the support of their west of Iran,” Epidemiology and Health, vol. 41, Article ID families, which further strengthened their confidence and e2019003, 2019. improved their quality of life. [5] H. Li, X. Sun, E. Miller et al., “BMI, reproductive factors, and In the whole process of case management, nurses pro- breast cancer molecular subtypes: a case-control study and vided the patients with a full range of efficient interventions meta-analysis,” Journal of Epidemiology, vol. 27, no. 4, to satisfy diverse needs at perioperative treatment and pp. 143–151, 2017. [6] N. M. Tung, J. C. Boughey, L. J. Pierce et al., “Management of promote recovery [14]. For instance, a preoperative as- hereditary breast cancer: American society of clinical on- sessment was carried out to screen out high-risk patients cology, American society for radiation oncology, and society with deep vein thrombosis, malnutrition, nausea, and of surgical oncology guideline,” Journal of Clinical Oncology, vomiting, and preventive measures were adopted to improve vol. 38, no. 18, pp. 2080–2106, 2020. their surgery tolerance and reduce pressure and achieve [7] S. S. Faubion, L. C. Larkin, C. A. Stuenkel et al., “Management postoperative recovery [15, 16]. Our findings indicated that of genitourinary syndrome of menopause in women with or at professional whole-process case management achieved a high risk for breast cancer: consensus recommendations from shorter duration of drainage tube placement and hospital- the North American Menopause Society and the International ization, a lower incidence of postoperative complications, Society for the Study of Women’s Sexual Health,” Menopause, and a better recovery versus general nursing, which were vol. 25, no. 6, pp. 596–608, 2018. consistent with the relevant studies. [8] J. T. Kapke, R. J. Schneidewend, Z. A. Jawa, C.-C. Huang, J. M. Connelly, and C. R. Chitambar, “High-dose intravenous Ongoing nursing is one of the most important segments methotrexate in the management of breast cancer with lep- in cancer case management [17]. After surgery, targeted tomeningeal disease: case series and review of the literature,” nursing is necessary because of its long course of postop- Hematology/Oncology and Stem Cell erapy, vol. 12, no. 4, erative healing [18]. Patients are mostly troubled by negative pp. 189–193, 2019. moods [19]. ,e humanistic care-centered case management [9] S. Shenoy and S. N. Shenoy, “Progeny in an inhospitable provides patients with good management of postoperative milieu-solitary intraventricular metastasis from a triple- recovery [20], which facilitates the patients’ psychological negative breast cancer mimicking central neurocytoma: case recovery and elimination of negative emotions [21]. Our report and review of diagnostic pitfalls and management findings indicated that the observation group was superior to strategies,” World Neurosurgery, vol. 135, pp. 309–315, 2020. the control group in terms of posttraumatic growth [10] N. J. Robert and N. Denduluri, “Patient case lessons: endo- crine management of advanced breast cancer,” Clinical Breast (P< 0.05), which may be attributed to the close monitoring Cancer, vol. 18, no. 3, pp. 192–204, 2018 Jun. of abnormal conditions. [11] R. Valhondo-Rama, C. G. Wakfie-Corieh, E. A. Rodr´ıguez In conclusion, the whole-process case management Gallo et al., “Contralateral axillary sentinel lymph node promotes the postoperative recovery of patients with triple- drainage in breast cancer: controversies and management negative breast cancer and shortens the indwelling time of according to the literature. A case report,” Revista Española de drainage tube and hospitalization, to further reduce post- Medicina Nuclear e Imagen Molecular, vol. 38, no. 5, operative complications, improve their quality of life, and pp. 316–319, 2019, English, Spanish. then enhance nursing satisfaction. [12] H.-W. Lai, S.-T. Chen, C. W. Mok et al., “Robotic versus conventional nipple sparing mastectomy and immediate gel implant breast reconstruction in the management of breast Data Availability cancer-A case control comparison study with analysis of clinical outcome, medical cost, and patient-reported cosmetic ,e datasets used during the present study are available from results,” Journal of Plastic, Reconstructive & Aesthetic Surgery, the corresponding author upon reasonable request. vol. 73, no. 8, pp. 1514–1525, 2020. [13] J. Eismann, Y. J. Heng, K. Fleischmann-Rose et al., “Inter- disciplinary management of transgender individuals at risk Conflicts of Interest for breast cancer: case reports and review of the literature,” ,e authors declare that they have no conflicts of interest. Clinical Breast Cancer, vol. 19, no. 1, pp. e12–e19, 2019. [14] B. D. Nugent, M. K. McCall, M. Connolly et al., “Protocol for symptom experience, management, outcomes, and adherence References in women receiving breast cancer chemotherapy,” Nursing Research, vol. 69, no. 5, pp. 404–411, 2020. [1] A. Radix, L. Wesp, and M. Deutsch, “Breast cancer screening, [15] C. W. Mok and H.-W. Lai, “Endoscopic-assisted surgery in management, and a review of case study literature in trans- the management of breast cancer: 20 years review of trend, gender populations,” Seminars in Reproductive Medicine, techniques and outcomes,” e Breast, vol. 46, pp. 144–156, vol. 35, no. 05, pp. 434–441, 2017. [2] D. Santa Mina, P. Brahmbhatt, C. Lopez et al., “,e case for [16] J. M. Simons, A. J. G. Maaskant-Braat, E. J. T. Luiten et al., prehabilitation prior to breast cancer treatment,” PM&R, “Patterns of axillary staging and management in clinically vol. 9, no. 9S2, pp. S305–S316, 2017. 6 Journal of Oncology node positive breast cancer patients treated with neoadjuvant systemic therapy: results of a survey amongst breast cancer specialists,” European Journal of Surgical Oncology, vol. 46, no. 1, pp. 53–58, 2020. [17] J. Berwart, B. Buonomo, F. A. Peccatori, A. Marioni, J. Lescano, and E. Pressel Coretto, “Management of HER2- positive breast cancer during pregnancy: a case report,” Tumori Journal, vol. 106, no. 6, pp. NP33–NP35, 2020. [18] K. J. Wu, “[Multidisciplinary cooperation strengthens indi- vidualized management of breast cancer in pregnancy],” Zhonghua Wai Ke Za Zhi, vol. 58, no. 2, pp. 95–98, 2020, Chinese. [19] A. Papalampros, E. Mpaili, D. Moris et al., “A case report on metastatic ileal neuroendocrine neoplasm to the breast masquerading as primary breast cancer,” Medicine, vol. 98, no. 16, Article ID e14989, 2019. [20] M. Y. Aldossary, F. Alquraish, and J. Alazhri, “A case of locally advanced breast cancer in a 59-year-old man requiring a modified approach to management,” American Journal of Case Reports, vol. 20, pp. 531–536, 2019. [21] B. Seroussi, J. B. Lamy, N. Muro et al., “Implementing guideline-based, experience-based, and case-based ap- proaches to enrich decision support for the management of breast cancer patients in the DESIREE project,” Studies in Health Technology and Informatics, vol. 255, pp. 190–194, http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Oncology Hindawi Publishing Corporation

The Application of Whole-Process Case Management in Patients with Triple-Negative Breast Cancer

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Copyright © 2022 Yunyan Zhao et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract

Hindawi Journal of Oncology Volume 2022, Article ID 1794288, 6 pages https://doi.org/10.1155/2022/1794288 Research Article The Application of Whole-Process Case Management in Patients with Triple-Negative Breast Cancer 1 2 2 2 2 2 2 Yunyan Zhao, Ran Zhu, Jie Bai, Jie Li, Xue Jia, Peng Wang, and Lijun Jin Department of Tumour Medicine Ward, Cangzhou Central Hospital, Cangzhou, China Department of yroid and Breast III, Cangzhou Central Hospital, Cangzhou, China Correspondence should be addressed to Lijun Jin; jinjishun434419038@163.com Received 21 December 2021; Revised 16 January 2022; Accepted 20 January 2022; Published 16 March 2022 Academic Editor: Wei long Zhong Copyright © 2022 Yunyan Zhao et al. ,is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To explore the application of professional whole-process case management during nursing in patients with triple- negative breast cancer. Methods. ,is study recruited 60 patients with triple-negative breast cancer who were diagnosed and treated at Department of Breast Surgery in our hospital assessed for eligibility between June 2018 and June 2020, and we assigned them at a ratio of 1 : 1 via the random number table method to receive either general nursing (control group) or professional whole-process case management plus general nursing (observation group). We analyzed and evaluated the hospitalization, the indwelling time of drainage tube, complications, recovery, quality of life, posttraumatic growth, and nursing satisfaction between these two groups at registration, discharge, and the sixth month after surgery, respectively. Results. Professional whole-process case management achieved a shorter duration of drainage tube placement and hospitalization and a lower incidence of post- operative complications versus general nursing (P< 0.05). Moreover, the observation group had got better recovery (P< 0.05) and a better quality of life at discharge and 6 months after surgery (P< 0.05). Professional whole-process case management obtained higher scores of posttraumatic growth and higher nursing satisfaction versus general nursing (P< 0.05). Conclusion. Whole- process case management promotes the postoperative recovery of patients with triple-negative breast cancer and shortens the duration of drainage tube indwelling and hospitalization, which lowers the incidence of postoperative complications, improves their quality of life, and enhances nursing satisfaction. characteristics, formulation of an personalized nursing plan 1. Introduction and follow-up visits, and high-quality nursing services [5]. Breast cancer is the most common cancer compromising the Whole-process case management gives full play to the quality of life and psychological health of women [1]. Its positive effect of personalized care in improving health treatment efficiency presents obvious enrichments as the management knowledge and trust and provides full atten- medical techniques advance with years [2]. However, pa- tion and follow-up support to patients’ health management tients are required to receive adjuvant chemotherapy despite knowledge and trust issues. It is a case-centered approach in receiving breast cancer surgery with curative intent and which case managers are responsible for coordinating and usually experience postoperative complications and side integrating the opinions of various professionals, making full effects from chemotherapy, which compromises their and effective use of medical resources, and providing dy- quality of life [3]. ,us, an urgent need exists to further namic, continuous, individualized, and comprehensive explore the improvement of quality of life, psychological professional guidance and consultation to patients to ensure health, and nursing satisfaction. Professional whole-process complete treatment and care for each case. Case manage- case management has been proposed in recent years with the ment is broadly used in diabetes, coronary heart disease, advances of nursing [4]. Whole-process case management, mental illness, and oncology. Research has indicated [6] that encompasses the integration of patients’ baseline the whole-process case management considerably enhances 2 Journal of Oncology Table 1: Comparison of general materials. the quality of life and is of great clinical significance for patients with breast cancer. Accordingly, this study was Observation Control t/χ2 P intended to explore the application of whole-process case group group management among 60 patients with triple-negative breast Age(years) 47.30± 8.26 46.43± 7.89 0.415 0.680 cancer. TNM stage Stage I 6 7 2. Materials and Methods Stage II 17 18 0.439 0.803 Stage III 7 5 2.1. General Materials. ,is study consisted of 60 patients Education level with triple-negative breast cancer who were diagnosed and Primary school 6 5 treated at the Department of Breast Surgery in our hospital Junior school 13 11 0.618 0.734 between June 2018 and June 2020, and we assigned them to High school or 11 14 an observation group (n � 30) and a control group (n � 30) above by random number table. ,e protocol of this study was ethically approved by the Ethics Committee of Cangzhou and adhered to the plan to complete the treatment course Central Hospital (approval no. 2017-12/341). ,e baseline according to the medical prescription. ,e nurses were also features of the two groups were similar (P> 0.05) (Table 1). required to grasp the type, degree, and risk factors of adverse reactions in each patient and deliver timely and appropriate 2.2.SelectionCriteria. Inclusion criteria [7]: (1) patients who risk prevention and adverse reaction control interventions. were diagnosed with triple-negative breast cancer. (2) Pa- ,e patients were instructed to actively carry out self-care tients who were in I stage and II stage as per American Joint activities to improve their ability to cope with the prevention Committee on Cancer (AJCC). (3) Patients with grade I or II and control of adverse reactions to radiotherapy. (3) During preoperative evaluation as per American Society of Anes- the hospitalization, nursing rounds were strengthened to thesiologists (ASA). (4) Patients who received modified closely monitor the patients’ adverse reactions after radio- radical mastectomy. (5) Patients with self-care ability, aged therapy, to maintain dynamic and continuous observation ≥18 years old, and with normal communication ability. (6) for those with milder reactions, to provide feedback to the Patients who received intravenous chemotherapy with attending physician for those with more severe reactions and anthracycline and paclitaxel after surgery. (7) Patients who to cooperate with symptomatic management care. (4) had completed and signed the informed consent form. Popularized postoperative nursing. ,e patients were given Exclusion criteria: (1) Patients with severe organ dysfunc- breast cancer rehabilitation guidelines, with verbal in- tion. (2) Patients with severe mental illness or disorders of structions on diet and physical rehabilitation training, consciousness. (3) Patients with distant organ metastasis. prevention and control of adverse reactions, daily life, and nursing care. ,ey were also supervised to record daily diet and exercise, adverse reactions, self-care, and daily living 2.3. Methods conditions, and the responsible nurses provided targeted 2.3.1. e Control Group. ,e control group received gen- individualized nursing interventions based on the issues in eral nursing during hospital stay. First, we provided patients the radiotherapy log. (5) Performed psychological nursing. with a complete professional examination and monitored ,e nursing staff conducted semistructured interviews and their conditions. Next, we took required measures for open-ended questions with the patients, without guidance complications and modified nursing plan with the changes and suggestion, and observed the changes in emotions and in their conditions. In addition, we followed the doctor’s expressions of the patients during communication to timely advice to offer corresponding perioperative nursing, drug identify their problems. In addition, the nurses helped pa- nursing, and diet management. tients to correctly understand radical breast cancer surgery and postoperative rehabilitation, provided information support and health education. ,e nurses provided sup- 2.3.2. e Observation Group. ,e observation group was portive emotional guidance, targeted psychological care and provided with whole-process case management during the emotional and counseling interventions, formulated indi- hospital stay. Specific measures were as follows: (1) a pro- vidualized strategies according to the patient’s condition, fessional case management team was built up. ,e head paid attention to the patient’s psychological state, and used nurse was the team leader, and nurses were organized to “psychological sand tray therapy” to help the patient release receive training of the whole process of professional case repressed emotions and cathartic methods to eliminate the management, and those who passed the exam were eligible patient’s negative emotions. to perform the case management employed in the present study. (2) ,e nurses issued case follow-up management record sheets to the patients, mastered the case radiotherapy 2.4. Observation Indicators plans and timing, dynamically observed the patients’ emotion, provided causal psychological counseling to pa- (1) We evaluated the quality of life of subjects at reg- istration, discharge, and six months after surgery as tients with excessive anxiety, fear, and depression, en- couraged the patients to overcome obstacles and difficulties, per the Chinese version of functional assessment of Journal of Oncology 3 cancer therapy-breast (FACT-B) that was composed 2.5. Statistical Analysis. In this study, SPSS25.0 statistical of the functional assessment of cancer therapy software was applied for data analyses. ,e measurement (FACT) scale used for the assessment of the quality data were expressed as mean± standard error and were of life and the breast cancer scale (BCS). FACT was tested by independent paired t-test or analysis of variance. composed of physical condition (7 items), social/ n(%) was used to represent the count data that were tested by family conditions (7 items), mental state (6 items), χ2 test. Differences were considered statistically significant at and functional status (7 items), and the BCS was P< 0.05. composed of 9 items, with five grades each item, ranging from 0 to 4 points. A higher score meant a 3. Results better quality of life. 3.1. Comparison of Hospital Stay and Indwelling Time of (2) We estimated the mental state via self-rating anxiety Drainage Tube. Professional whole-process case manage- scale (SAS) and self-rating depression scale (SDS) at ment achieved a shorter duration of drainage tube place- discharge. SAS was composed of 20 projects, and the ment and hospitalization and a lower incidence of integer of the summation of all items × 1.25 was postoperative complications versus general nursing defined as standard. A higher score meant more (P< 0.05) (Table 2). severe anxiety. It was defined as normal if the scores were under 50 points, mild if 50 to 60 points, moderate if 61 to 70 points, and severe if more than 3.2. Comparison of Quality of Life Scores. No statistically 70 points. SDS was composed of 20 items, and its significant differences were found in the quality of life be- calculation was the same as SAS, and a higher score tween the two groups before treatment (P> 0.05). ,e ob- meant that symptoms were more severe. It was servation group had a better quality of life at discharge and normal if the scores were under 53 points, mild if 6 months after surgery (P< 0.05) (Table 3). 53–62 points, moderate if 63–72 points, and severe if more than 72 points. 3.3. Comparison of Mental State and Nursing at Discharge. (3) We assessed the nursing satisfaction at discharge ,e mental state of the observation group was superior to using a self-made questionnaire (a total score of 100 that of the control group (P< 0.05). Patients in the obser- points). vation group were more satisfied with the nursing than those in the control group (P< 0.05). (Table 4). (4) We assessed the posttraumatic growth with the use of the posttraumatic growth inventory (PTGI) at registration, discharge, and six months after surgery. 3.4. Comparison of the Shoulder Joint Recovery of the Affected ,is scale designed by Tedsky in 1996 was composed Limb. Professional whole-process case management of 21 items from five aspects of interpersonal rela- showed more significant improvements in the shoulder joint tionships, potentials, personal strength, mental recovery of the affected limb versus general nursing changes, and appreciation of life. In addition, Likert (P< 0.05) (Table 5). was used to scale. ,e score was proportional to posttraumatic growth. 3.5. Comparison of Posttraumatic Growth. When comparing (5) We calculated the complication rate six months after the posttraumatic growth scores between the two groups, we surgery. Common complications included postop- found that there were no significant between the two groups erative bleeding, postoperative incision infection, at registration, while the observation group was superior to axillary lymphatic leakage, and loss of appetite. the control group at discharge and six months after surgery Complication rate � (complication numbers/total) × (P< 0.05) (Table 6). 100%. (6) We observed the recovery of the affected limb and 3.6. Comparison of the Incidence of Complications. In the complications and evaluated the efficacy based on observation group, there were 2 cases with postoperative the postoperative shoulder joint range of motion bleeding, 1 case with postoperative infection, 2 cases with (ROM) [8] at discharge and six months after axillary lymphatic leakage, and 2 cases with loss of appetite. surgery. ,e standard of ROM was that the In the control group, there were 5 cases with postoperative ° ° shoulder joint bent forward 0 –180 , stretched bleeding, 3 cases with postoperative infection, 4 cases with ° ° ° ° backward 0 –50 , stretched outside 0 –180 , and axillary lymphatic leakage, and 6 cases with loss of appetite. ° ° turned 0 –90 . It was good if the shoulder joint bent ,e observation group showed a lower incidence of post- ° ° forward 0–160 , stretched backward 0–40 , operative complications than the control group (P< 0.05) ° ° stretched outside 0–160 , and rotated 0–60 inside (Table 7). and outside, respectively. It was poor if the shoulder joint bent forward 0–140 , stretched 4. Discussion ° ° backward 0–30 , stretched outside 0–140 , and rotated 0–30 inside and outside, respectively. Both Breast cancer is a malignancy that threatens the health of groups were followed up for 6 months. women [9]. Treatment shows an individual and 4 Journal of Oncology Table 2: Comparison of hospital stays and indwelling time of drainage tube. n Indwelling time of drainage tube (d) Hospital stays (d) Observation group 30 11.13± 5.17 11.66± 3.92 Control group 30 14.20± 4.31 14.53± 4.10 t 2.495 2.764 P 0.020 0.010 Table 3: Comparison of quality-of-life scores. n Registration Discharge Six months after surgery Observation group 30 86.83± 7.14 103.16± 7.61 110.83± 6.15 Control group 30 84.96± 4.31 91.30± 6.32 93.96± 5.42 t 0.937 6.567 11.251 P 0.350 <0.001 <0.001 Table 4: Comparison of mental state and nursing at discharge. n SAS SDS Nursing satisfaction Observation group 30 62.50± 5.85 62.16± 5.50 105.13± 5.66 Control group 30 53.63± 7.01 53.30± 7.40 82.40± 7.20 t 5.316 5.264 13.578 P <0.001 <0.001 <0.001 Table 5: Comparison of the shoulder joint recovery of the affected limb. At discharge Six months after surgery Excellent Good Poor Excellent Good Poor Observation group 30 17 10 3 25 5 0 Control group 30 5 15 10 6 18 6 χ2 11.315 24.993 P 0.003 <0.001 Table 6: Comparison of posttraumatic growth. n Registration Discharge Six months after surgery Observation group 30 47.43± 6.70 69.10± 5.79 88.76± 6.45 Control group 30 45.96± 6.54 57.63± 5.98 72.96± 6.44 t 0.857 7.541 9.492 P 0.395 <0.001 <0.001 Table 7: Comparison of the incidence of complications. n Postoperative bleeding Postoperative infection Axillary lymphatic leakage Loss of appetite Incidence Observation group 30 2 1 2 2 7(23.33) Control group 30 5 3 4 6 18(60.00) χ2 8.297 P 0.004 multidisciplinary pattern with the ongoing development of and mental state benefits the quality of life. It has been medical management, which contributes to the enrichments reported that the whole-process case management offers of efficacy [10]. Mental evaluation and targeted counseling patients good family and social support, thereby promoting are used to alleviate the patients’ excessive depression and their mental health and quality of life [13]. ,e present study anxiety, for a better treatment result [11]. revealed a better quality of life in patients given case Quality of life indirectly reflects the efficacy and is also management versus general nursing, which may be attrib- one of the essential factors indicating the alleviation of uted to the constant evaluation of the patients’ mental state symptoms and recovery [12]. ,e improvement of physical and the prompt resolution of potential risk during recovery. Journal of Oncology 5 [3] C. Vila, C. Reñones, T. 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Journal of Oncology – Hindawi Publishing Corporation

Published: Mar 16, 2022

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