- Email: [email protected]
An audit of axillary node recurrence in patients undergoing sentinel lymph node biopsy in Altnagelvin Hospital
510 and continually updated at each clinic or inpatient visit to ensure that all aspects of the guidance are covered.
ABSTRACTS Conclusions: The axillary recurrence rate in our series compares favourably with the target axillary recurrence rate of < 3% defined by the Association of Breast Surgery at BASO guidelines 2009 (1).
http://dx.doi.org/10.1016/j.ejso.2013.01.210 Reference P175. Cancer survivorship: A 2 year service evaluation of ‘Recoup Your Equilibrium’ Joanna Rowley, Pat Skelly, Gill Clayton Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
Introduction: Patients are well supported during their initial diagnosis, surgery and treatment. Following completion of therapy, low risk patients are discharged from clinical follow up to patient led follow up. As part of the National Cancer Survivorship Initiative increasing emphasis is being placed on strategies for long term assistance. Methods: Patients finishing their current breast cancer treatment were invited to a workshop entitled ‘Recoup Your Equilibrium’. Run by Specialist Breast Care Nurses and in conjunction with support from a dietician and physiotherapist, topics as diverse as post surgical changes, lymphoedema, body image and sexuality were discussed. A booklet was produced providing further written information and support. Questionnaires were sent to patients at the end of each workshop. Results: 73 patients (40% of those invited) attended during the first 12 months. This was increased to 87 patients (56% of those invited) for the year period ending 2011. Patient satisfaction was high with 93% reporting the group content as excellent or good. 100% of patients found the ‘Recoup Your Equilibrium’ booklet clear and easy to understand. 100% of patients found the booklet helped them understand what to expect following treatment. 100% of patients found it useful to attend the focus group. Conclusions: ‘Recoup Your Equilibrium’ provides ongoing support to breast cancer survivors and achieves high patient satisfaction. This is a useful adjunct in patient care and future directions include follow up patient contact by telephone call and the availability of a life coach. http://dx.doi.org/10.1016/j.ejso.2013.01.211
P176. An audit of axillary node recurrence in patients undergoing sentinel lymph node biopsy in Altnagelvin Hospital Igor Rychlik, Aaron Ferguson, Iain Cameron, Janne Bingham, Helen Mathers Altnagelvin Area Hospital, Londonderry, UK
1. Bishop H, Chan C, Monypenny I, Patnick J, Sibbering M, Watkins R, Winstanley J, Bundred N, Corder A, Nicholson S, Robertson J, Rothnie N, Davies L. Surgical guidelines for the management of breast cancer. Eur J Surg Oncol. 2009;35 Suppl 1:1-22 http://dx.doi.org/10.1016/j.ejso.2013.01.212
P177. Quality improvement project: Protecting at risk arms from breast cancer related lymphoedema Rosemary Sedgwick, Sophie Bates, Dibendu Betal, Ayesha Kahn, Giles Davies, Richard Cummins, Karyn Shenton Kingston Hospital, Kingston, Surrey, UK
Introduction: Procedures such as venepuncture and cannulation can precipitate Breast Cancer Related Lymphoedema (BCRL) in patients who have undergone axillary surgery. We noted that procedures were inadvertently being performed on the side of surgery at our hospital, as susceptible patients were not clearly identifiable to staff. Methods: We conducted an online anonymous staff survey, to measure the scale of the problem. 26.9% of responders reported having seen procedures being performed on at risk arms in non-emergency settings. 83.3% of responders felt an intervention to allow easy identification of at risk arms would be useful. We created a threefold intervention. Firstly, we created an ‘At Risk Arm’ alert on the computerised records system. Secondly, we produced a warning sign for each susceptible patient’s bed. The signs are displayed above beds, and returned to notes for use if the patient is re-admitted. Thirdly, we informed GPs via discharge summaries of the need to perform procedures on the opposite side to surgery. Results: We conducted a second staff survey after implementation. 46.2% felt that the new interventions would decrease the chance of patients developing BCRL. 61.5% felt that susceptible patients being more identifiable to staff would decrease the likelihood of procedures being performed on at risk arms. Conclusion: Our project showed the importance of ensuring axillary surgery patients are identifiable to staff during admission. Further interventions could include wristbands or patient alert cards. This work could be extended to include primary care and outpatient settings. http://dx.doi.org/10.1016/j.ejso.2013.01.213
Introduction: Minimal surgery, rather than lymph node clearance, should be performed to stage the axilla in patients with early invasive breast cancer and no evidence of lymph node involvement. Sentinel lymph node biopsy (SLNB) is the preferred technique. With widespread adoption of SLNB, NICE has advised that breast units should audit their axillary recurrence rates. Methods: Consecutive patients undergoing SLNB in Altnagelvin Hospital between April 2007 and October 2009 were identified. Patient demographics, primary breast cancer characteristics and treatment, and patient outcomes were obtained from laboratory, patient centre and oncology databases. Details on presentation and management of the axillary recurrence were obtained from hospital records. Primary end points were axillary relapse rate and time interval between primary breast cancer diagnosis and axillary recurrence. Results: A total of 318 patients underwent SLNB in this time period. Median number of harvested nodes was 2 (range 1-9). Median age of the cohort was 58 years (range 28-95). After a median follow-up of 53 months (range 38-68), 6 patients (1.89%) developed recurrence in the axilla with associated breast recurrence in one case. One underwent mastectomy and 5 patients had wide local excision. The median interval between primary breast cancer diagnosis and axillary recurrence was 28 months (range 10-50).
P178. Free flaps for whole breast reconstruction: 8 years, 100 cases, evolving trends, increasing acceptance - Tata Memorial Centre, India experience Prabha Yadav, Dushyant Jaiswal, Vinaykant Shankhdhar, Prashant Puranik Tata Memorial Centre, Mumbai Maharashtra, India
Introduction: The gold standard for whole breast reconstruction, free diep, mstram flaps in India has been stuck in the muddy troika of lack of expertise available, under-utilisation if expertise available, poor awareness and acceptability amongst patients. All these factors feed on each other. We have achieved breakthrough results, awareness and acceptability with 100 plus cases over the past 8 years Methods: 104 cases of whole breast reconstruction (WBR) were done from April 2004 to Nov 2012 with free flaps, of these 70 cases were operated in last 2 years. 1 case was bilateral reconstruction, rest unilateral. 10
ABSTRACTS Conclusions: The axillary recurrence rate in our series compares favourably with the target axillary recurrence rate of < 3% defined by the Association of Breast Surgery at BASO guidelines 2009 (1).
http://dx.doi.org/10.1016/j.ejso.2013.01.210 Reference P175. Cancer survivorship: A 2 year service evaluation of ‘Recoup Your Equilibrium’ Joanna Rowley, Pat Skelly, Gill Clayton Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
Introduction: Patients are well supported during their initial diagnosis, surgery and treatment. Following completion of therapy, low risk patients are discharged from clinical follow up to patient led follow up. As part of the National Cancer Survivorship Initiative increasing emphasis is being placed on strategies for long term assistance. Methods: Patients finishing their current breast cancer treatment were invited to a workshop entitled ‘Recoup Your Equilibrium’. Run by Specialist Breast Care Nurses and in conjunction with support from a dietician and physiotherapist, topics as diverse as post surgical changes, lymphoedema, body image and sexuality were discussed. A booklet was produced providing further written information and support. Questionnaires were sent to patients at the end of each workshop. Results: 73 patients (40% of those invited) attended during the first 12 months. This was increased to 87 patients (56% of those invited) for the year period ending 2011. Patient satisfaction was high with 93% reporting the group content as excellent or good. 100% of patients found the ‘Recoup Your Equilibrium’ booklet clear and easy to understand. 100% of patients found the booklet helped them understand what to expect following treatment. 100% of patients found it useful to attend the focus group. Conclusions: ‘Recoup Your Equilibrium’ provides ongoing support to breast cancer survivors and achieves high patient satisfaction. This is a useful adjunct in patient care and future directions include follow up patient contact by telephone call and the availability of a life coach. http://dx.doi.org/10.1016/j.ejso.2013.01.211
P176. An audit of axillary node recurrence in patients undergoing sentinel lymph node biopsy in Altnagelvin Hospital Igor Rychlik, Aaron Ferguson, Iain Cameron, Janne Bingham, Helen Mathers Altnagelvin Area Hospital, Londonderry, UK
1. Bishop H, Chan C, Monypenny I, Patnick J, Sibbering M, Watkins R, Winstanley J, Bundred N, Corder A, Nicholson S, Robertson J, Rothnie N, Davies L. Surgical guidelines for the management of breast cancer. Eur J Surg Oncol. 2009;35 Suppl 1:1-22 http://dx.doi.org/10.1016/j.ejso.2013.01.212
P177. Quality improvement project: Protecting at risk arms from breast cancer related lymphoedema Rosemary Sedgwick, Sophie Bates, Dibendu Betal, Ayesha Kahn, Giles Davies, Richard Cummins, Karyn Shenton Kingston Hospital, Kingston, Surrey, UK
Introduction: Procedures such as venepuncture and cannulation can precipitate Breast Cancer Related Lymphoedema (BCRL) in patients who have undergone axillary surgery. We noted that procedures were inadvertently being performed on the side of surgery at our hospital, as susceptible patients were not clearly identifiable to staff. Methods: We conducted an online anonymous staff survey, to measure the scale of the problem. 26.9% of responders reported having seen procedures being performed on at risk arms in non-emergency settings. 83.3% of responders felt an intervention to allow easy identification of at risk arms would be useful. We created a threefold intervention. Firstly, we created an ‘At Risk Arm’ alert on the computerised records system. Secondly, we produced a warning sign for each susceptible patient’s bed. The signs are displayed above beds, and returned to notes for use if the patient is re-admitted. Thirdly, we informed GPs via discharge summaries of the need to perform procedures on the opposite side to surgery. Results: We conducted a second staff survey after implementation. 46.2% felt that the new interventions would decrease the chance of patients developing BCRL. 61.5% felt that susceptible patients being more identifiable to staff would decrease the likelihood of procedures being performed on at risk arms. Conclusion: Our project showed the importance of ensuring axillary surgery patients are identifiable to staff during admission. Further interventions could include wristbands or patient alert cards. This work could be extended to include primary care and outpatient settings. http://dx.doi.org/10.1016/j.ejso.2013.01.213
Introduction: Minimal surgery, rather than lymph node clearance, should be performed to stage the axilla in patients with early invasive breast cancer and no evidence of lymph node involvement. Sentinel lymph node biopsy (SLNB) is the preferred technique. With widespread adoption of SLNB, NICE has advised that breast units should audit their axillary recurrence rates. Methods: Consecutive patients undergoing SLNB in Altnagelvin Hospital between April 2007 and October 2009 were identified. Patient demographics, primary breast cancer characteristics and treatment, and patient outcomes were obtained from laboratory, patient centre and oncology databases. Details on presentation and management of the axillary recurrence were obtained from hospital records. Primary end points were axillary relapse rate and time interval between primary breast cancer diagnosis and axillary recurrence. Results: A total of 318 patients underwent SLNB in this time period. Median number of harvested nodes was 2 (range 1-9). Median age of the cohort was 58 years (range 28-95). After a median follow-up of 53 months (range 38-68), 6 patients (1.89%) developed recurrence in the axilla with associated breast recurrence in one case. One underwent mastectomy and 5 patients had wide local excision. The median interval between primary breast cancer diagnosis and axillary recurrence was 28 months (range 10-50).
P178. Free flaps for whole breast reconstruction: 8 years, 100 cases, evolving trends, increasing acceptance - Tata Memorial Centre, India experience Prabha Yadav, Dushyant Jaiswal, Vinaykant Shankhdhar, Prashant Puranik Tata Memorial Centre, Mumbai Maharashtra, India
Introduction: The gold standard for whole breast reconstruction, free diep, mstram flaps in India has been stuck in the muddy troika of lack of expertise available, under-utilisation if expertise available, poor awareness and acceptability amongst patients. All these factors feed on each other. We have achieved breakthrough results, awareness and acceptability with 100 plus cases over the past 8 years Methods: 104 cases of whole breast reconstruction (WBR) were done from April 2004 to Nov 2012 with free flaps, of these 70 cases were operated in last 2 years. 1 case was bilateral reconstruction, rest unilateral. 10