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.