- Email: [email protected]
Cancer experiences in people with an intellectual disability: A PhD thesis
ABSTRACTS
S237
with the diagnosis, being given a genetic risk and unexpectedly making rapid decisions about FP before treatment starts, must be considered. Such discussions require the input of Reproductive Medicine (RM) and Genetics specialists and demanded a clear pathway. Method: Multidisciplinary meetings identified issues that needed to be addressed within the pathway. The proposals were discussed with the local cancer network, RM & Genetics teams. Results: Patients’ age, prognosis, planned cancer treatment, ovarian reserve, funding, relationship status, timing of genetic test results and likelihood of success were the major issues considered. Our team designed a clear structured pathway for cancer patients considering FP with or without a genetic risk, which is being introduced across our region. Conclusion: Aim of pathway is to allow patients time for reflection, provide comprehensive information and enable optimum choice thus preventing post decision-making regret. This pathway provides a potential template for use in other UK regions. http://dx.doi.org/10.1016/j.ejso.2016.07.081
221. Evaluation of sentinel lymph node metastatic deposit size and extracapsular spread on further axillary spread in breast cancer patients Eline Caine1, Thomas Newman2, Veronika Pronisceva1, Anil Poddar1, Elizabeth Sharp1 1 East Kent Hospitals University NHS Foundation Trust, UK 2 Brighton and Sussex University Hospitals NHS Trust, UK Background: Management of the axilla after identification of one or two sentinel lymph nodes containing metastases remains controversial. The ABS Consensus Statement ‘Management of the Malignant Axilla in Early Breast Cancer (2015)’ states that patients with T1, G1, G2, ER+ and HER2-disease with 1e2 sentinel nodes and macro metastases may not need further clearance. The most commonly used predictor of additional nodal disease is the MSKCC nomogram. However, whether metastatic deposit size and extracapsular spread in sentinel lymph node affects further axillary spread, has not been established. Our aim is to determine if metastatic deposit size and extra capsular spread in sentinel lymph nodes, affects final axillary nodal burden. Method: From April 2009 to October 2015, 110 patients with positive sentinel node biopsies were reviewed retrospectively, excluding micro metastases. 84 patients had further axillary node clearance. Data was analysed using Spearman’s correlation coefficient, logistic regression analysis and Chi squared. Results: There is a significant correlation between the metastatic deposit size and number of further axillary nodes (R ¼ 0.244, P ¼ 0.002). There is no significant increased risk of further axillary spread with extracapsular spread (O.R. 0.866, 95% CI 0.3296e2.2273). There was no significant difference in risk of further spread between the grouped metastatic sizes. Metastatic deposit size (mm)
Total nodal burden (%) No further N1e3 N4e9 N > 9 axillary spread (N1) (N2) (N3) (%)
Further axillary spread (%)
2e4.9 5e5.9 >8
90.9 85.2 66.7
30.3 29.6 50.0
9.1 14.8 16.7
0.0 0.0 16.7
69.7 70.4 50.0
Conclusion: Statistically, there is no significant increase between metastatic deposit size and the likelihood of further spread. However, our data suggests that if there is further spread, there is significant correlation between increase in metastatic deposit size and extent of further nodal burden. The presence of extracapsular spread does not increase risk of further axillary spread. http://dx.doi.org/10.1016/j.ejso.2016.07.082
223. Cancer experiences in people with an intellectual disability: A PhD thesis Samantha Flynn1, Nick Hulbert-Williams1, Lee Hulbert-Williams1, Ros Bramwell2 1 Chester Research Unit for the Psychology of Health, UK 2 University of Chester, UK Background: Increasing numbers of people with an intellectual disability (ID) are being diagnosed with cancer, but experiences of this population are seldom researched. Undoubtedly, it will be as distressing as it is for those without ID; however, additional needs may be present. This PhD thesis explored the cancer-related experiences of people with ID, and the impact on those who support them. Method: The thesis comprises four studies: (1) A systematic review of the psychosocial experiences of chronic illness in people with ID. (2) Interviews with six people with ID and cancer and 12 linked participants (family members, Health and Social Care Professionals), using grounded theory methodology. (3) A survey of oncology nurses (n ¼ 83) regarding their attitudes, and care perceptions of four fictional patient vignettes. (4) A training intervention to improve oncology professionals’ perceptions of communicating with a person with ID. Results: (1) There is a paucity of literature (n ¼ 4), with findings suggesting that people with ID have difficulties in understanding their illness, and recognising the signs of the onset of illness. (2) Furthermore, participants were often not involved in discussions and decisions; leading to increased anxiety and disengagement from diagnosis and treatment. The psychological vulnerability of this population is often not recognised by healthcare professionals. (3) Oncology nurses felt unconfident caring for and communicating with patients with ID; however, prior ID experience seemed to mitigate this. (4) Data collection is underway, and analysis will take place in August 2016. Conclusion: (1) A substantial research gap was identified; thus further empirical work was necessary to address this. (2) Participants experienced many common difficulties faced by non-ID samples, however, the incidence of difficulty and unmet needs were substantially greater. (3) Caring for cancer patients with ID may intensify an already difficult role; appropriate training may lessen these effects. (4) Based on previous findings, we expect the intervention to improve perceptions of communicating with people with ID and cancer. http://dx.doi.org/10.1016/j.ejso.2016.07.083
228. Does access to health services influence the diagnostic pathway and outcome from cancer: Analysis of a linked dataset Melanie Turner, Shona Fielding, Peter Murchie University of Aberdeen, UK Background: Cancer treatment in the UK is generally delivered in large cancer centres within major cities. It is currently unknown whether a persons’ geographical location within the UK and subsequent travelling time to health services has implications for the timeliness of their receipt of a diagnosis and treatment for cancer. This study aimed to determine whether cancer diagnostic pathways and survival are affected by access to GP practice, diagnostic centre and cancer treatment centre. Method: Routine clinical data from Scottish Morbidity Record (SMR) 01, Scottish Cancer Registry SMR 06, and Geographical Information Systems (GIS) derived measures of travelling times from key healthcare facilities have been linked to a clinical tracking database, NHS Grampian Cancer Care Pathway to form the Northeast and Aberdeen Scotland Cancer and Residence (NASCAR) database. This linkage provided a retrospective cohort of 13,702 people diagnosed with cancer since 2007. Logistic regression analyses have been conducted to determine the effect of travelling time from services on provider delays and survival at one year following diagnosis. Results: Patients residing on the mainland greater than 60 minutes travelling time from their cancer centre [OR 1.42; CI 1.25e1.61] and those
S237
with the diagnosis, being given a genetic risk and unexpectedly making rapid decisions about FP before treatment starts, must be considered. Such discussions require the input of Reproductive Medicine (RM) and Genetics specialists and demanded a clear pathway. Method: Multidisciplinary meetings identified issues that needed to be addressed within the pathway. The proposals were discussed with the local cancer network, RM & Genetics teams. Results: Patients’ age, prognosis, planned cancer treatment, ovarian reserve, funding, relationship status, timing of genetic test results and likelihood of success were the major issues considered. Our team designed a clear structured pathway for cancer patients considering FP with or without a genetic risk, which is being introduced across our region. Conclusion: Aim of pathway is to allow patients time for reflection, provide comprehensive information and enable optimum choice thus preventing post decision-making regret. This pathway provides a potential template for use in other UK regions. http://dx.doi.org/10.1016/j.ejso.2016.07.081
221. Evaluation of sentinel lymph node metastatic deposit size and extracapsular spread on further axillary spread in breast cancer patients Eline Caine1, Thomas Newman2, Veronika Pronisceva1, Anil Poddar1, Elizabeth Sharp1 1 East Kent Hospitals University NHS Foundation Trust, UK 2 Brighton and Sussex University Hospitals NHS Trust, UK Background: Management of the axilla after identification of one or two sentinel lymph nodes containing metastases remains controversial. The ABS Consensus Statement ‘Management of the Malignant Axilla in Early Breast Cancer (2015)’ states that patients with T1, G1, G2, ER+ and HER2-disease with 1e2 sentinel nodes and macro metastases may not need further clearance. The most commonly used predictor of additional nodal disease is the MSKCC nomogram. However, whether metastatic deposit size and extracapsular spread in sentinel lymph node affects further axillary spread, has not been established. Our aim is to determine if metastatic deposit size and extra capsular spread in sentinel lymph nodes, affects final axillary nodal burden. Method: From April 2009 to October 2015, 110 patients with positive sentinel node biopsies were reviewed retrospectively, excluding micro metastases. 84 patients had further axillary node clearance. Data was analysed using Spearman’s correlation coefficient, logistic regression analysis and Chi squared. Results: There is a significant correlation between the metastatic deposit size and number of further axillary nodes (R ¼ 0.244, P ¼ 0.002). There is no significant increased risk of further axillary spread with extracapsular spread (O.R. 0.866, 95% CI 0.3296e2.2273). There was no significant difference in risk of further spread between the grouped metastatic sizes. Metastatic deposit size (mm)
Total nodal burden (%) No further N1e3 N4e9 N > 9 axillary spread (N1) (N2) (N3) (%)
Further axillary spread (%)
2e4.9 5e5.9 >8
90.9 85.2 66.7
30.3 29.6 50.0
9.1 14.8 16.7
0.0 0.0 16.7
69.7 70.4 50.0
Conclusion: Statistically, there is no significant increase between metastatic deposit size and the likelihood of further spread. However, our data suggests that if there is further spread, there is significant correlation between increase in metastatic deposit size and extent of further nodal burden. The presence of extracapsular spread does not increase risk of further axillary spread. http://dx.doi.org/10.1016/j.ejso.2016.07.082
223. Cancer experiences in people with an intellectual disability: A PhD thesis Samantha Flynn1, Nick Hulbert-Williams1, Lee Hulbert-Williams1, Ros Bramwell2 1 Chester Research Unit for the Psychology of Health, UK 2 University of Chester, UK Background: Increasing numbers of people with an intellectual disability (ID) are being diagnosed with cancer, but experiences of this population are seldom researched. Undoubtedly, it will be as distressing as it is for those without ID; however, additional needs may be present. This PhD thesis explored the cancer-related experiences of people with ID, and the impact on those who support them. Method: The thesis comprises four studies: (1) A systematic review of the psychosocial experiences of chronic illness in people with ID. (2) Interviews with six people with ID and cancer and 12 linked participants (family members, Health and Social Care Professionals), using grounded theory methodology. (3) A survey of oncology nurses (n ¼ 83) regarding their attitudes, and care perceptions of four fictional patient vignettes. (4) A training intervention to improve oncology professionals’ perceptions of communicating with a person with ID. Results: (1) There is a paucity of literature (n ¼ 4), with findings suggesting that people with ID have difficulties in understanding their illness, and recognising the signs of the onset of illness. (2) Furthermore, participants were often not involved in discussions and decisions; leading to increased anxiety and disengagement from diagnosis and treatment. The psychological vulnerability of this population is often not recognised by healthcare professionals. (3) Oncology nurses felt unconfident caring for and communicating with patients with ID; however, prior ID experience seemed to mitigate this. (4) Data collection is underway, and analysis will take place in August 2016. Conclusion: (1) A substantial research gap was identified; thus further empirical work was necessary to address this. (2) Participants experienced many common difficulties faced by non-ID samples, however, the incidence of difficulty and unmet needs were substantially greater. (3) Caring for cancer patients with ID may intensify an already difficult role; appropriate training may lessen these effects. (4) Based on previous findings, we expect the intervention to improve perceptions of communicating with people with ID and cancer. http://dx.doi.org/10.1016/j.ejso.2016.07.083
228. Does access to health services influence the diagnostic pathway and outcome from cancer: Analysis of a linked dataset Melanie Turner, Shona Fielding, Peter Murchie University of Aberdeen, UK Background: Cancer treatment in the UK is generally delivered in large cancer centres within major cities. It is currently unknown whether a persons’ geographical location within the UK and subsequent travelling time to health services has implications for the timeliness of their receipt of a diagnosis and treatment for cancer. This study aimed to determine whether cancer diagnostic pathways and survival are affected by access to GP practice, diagnostic centre and cancer treatment centre. Method: Routine clinical data from Scottish Morbidity Record (SMR) 01, Scottish Cancer Registry SMR 06, and Geographical Information Systems (GIS) derived measures of travelling times from key healthcare facilities have been linked to a clinical tracking database, NHS Grampian Cancer Care Pathway to form the Northeast and Aberdeen Scotland Cancer and Residence (NASCAR) database. This linkage provided a retrospective cohort of 13,702 people diagnosed with cancer since 2007. Logistic regression analyses have been conducted to determine the effect of travelling time from services on provider delays and survival at one year following diagnosis. Results: Patients residing on the mainland greater than 60 minutes travelling time from their cancer centre [OR 1.42; CI 1.25e1.61] and those