Return to work of breast cancer survivors: a systematic review of intervention studies

<p>Abstract</p> <p>Background</p> <p>Breast cancer management has improved dramatically in the past three decades and as a result, a population of working age women is breast cancer survivor. Interventions for breast cancer survivors have shown improvements in quality of life and in physical and psychological states. In contrast, efforts aimed at stimulating re-employment and return-to-work interventions for breast cancer survivors have not kept pace. The objective of this review was to study the effects and characteristics of intervention studies on breast cancer survivors in which the outcome was return to work.</p> <p>Methods</p> <p>The Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2006), Medline, Ovid, EMBASE and PsychInfo were systematically searched for studies conducted between 1970 to February 2007. Intervention studies for female breast cancer survivors that were focused on return to work were included.</p> <p>Results</p> <p>Our search strategy identified 5219 studies. Four studies out of 100 potentially relevant abstracts were selected and included 46–317 employed women who had had mastectomy, adjuvant therapy and rehabilitation, with the outcome return to work. The intervention programs focused on improvement of physical, psychological and social recovery. Although a substantial percentage (between 75% to 85%) of patients included in these studies returned to work after rehabilitation, it is not clear whether this proportion would have been lower for patients without counseling or exercise, or any other interventions, as three out of four studies did not include a comparison group.</p> <p>Conclusion</p> <p>The most important finding of this review is the lack of methodologically sound intervention studies on breast cancer survivors with the outcome return to work. Using evidence from qualitative and observational studies on cancer and the good results of intervention studies on return to work programs and vocational rehabilitation, return to work interventions for breast cancer survivors should be further developed and evaluated.</p

Melolabial fold interpolated flap for reconstruction of complex nasal defects Retalho interpolado do sulco melolabial para reconstrução de defeitos complexos do nariz

Complex surgical nasal defects are often technically difficult. We report the case of a 71-year old male diagnosed with a malignant melanoma (animal type; Breslow 1.5; Clark IV) on the right nasal ala. Radial excision with margins of approximately 1.5cm was performed, creating a complex full-thickness surgical defect involving the free wall and margin of the right nasal ala, the right soft triangle, nasal lobe and columella, which was reconstructed using a melolabial interpolated flap, with highly satisfactory final esthetic result. Interpolated flaps are viable surgical options for the reconstruction of surgical defects for which local flaps and skin grafts are not suitable.<br>A reconstrução de defeitos cirúrgicos complexos do nariz é, por norma, tecnicamente difícil. Apresentamos um doente do sexo masculino, de 71 anos, referenciado após biopsia excisional de melanoma maligno de tipo animal (Breslow 1,5 mm, Clark IV) da asa direito do nariz. O alargamento excisional com margem de 1,5 cm originou um defeito complexo envolvendo a asa nasal direita, o triângulo mole direito, o lobo nasal e a columela, que foi reconstruído por retalho interpolado do sulco melolabial, com resultado cosmético final bastante satisfatório. Os retalhos interpolados são opções cirúrgicas eficazes para reconstrução de defeitos cutâneos para os quais a realização de retalhos locais não é possível e a colocação de enxertos inviabiliza um resultado cosmético aceitável