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DCIS - do we know what we're doing?
1002
ABSTRACTS
with higher liaison with plastic surgeons. These may influence job planning of breast oncoplastic surgeons in future. P73. Impact of therapeutic hypnosis on pain and anxiety in patients undergoing breast cancer surgery Eamonn Coveney, M. Grieve, B. Kumar Department of Surgery, West Suffolk Hospital NHS Trust, Hardwick Lane, Bury St Edmunds, Suffolk, IP33 2QZ Introduction: Patients undergoing operations for breast cancer frequently experience distress and their recovery can be negatively impacted by a variety of postoperative complications. This study explores the impact of a brief hypnosis intervention on preoperative anxiety and postoperative experience of patients undergoing surgery for breast cancer. Methods: Seventy-seven patients were offered hypnosis on day of admission for breast cancer surgery. Patients choosing hypnosis (n¼39) underwent a 15 minute hypnotic based intervention on the ward where therapeutic suggestions for reduced anxiety, pain, nausea and fatigue were given. Patients were assessed for anxiety on admission and in the anaesthetic room with pain, nausea and fatigue assessed upon discharge using a visual analogue scale (1-100). Results: Hypnosis Control P value* Effect size (meanSD) (meanSD) d Number 39 Ward Anxiety 47 32 Anaesthetic room Anxiety 25 24 Pain 18 16 Nausea 12 24 Fatigue 34 29
38 39 46 30 19 42
24 26 24 32 31
0.0002 0.02 0.17 0.18
0.87 0.22 0.28 0.28
P75. DCIS - do we know what we’re doing? Adam Hassani, C. Griffith, J. Harvey Newcastle-upon-Tyne Hospitals, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne, NE1 4LP Introduction: Optimal margins for Wide Local Excision have not been clearly established. Larger margins lead to lower recurrence rates but at the expense of cosmetic appearance. NICE guidelines recommend a 2mm margin for Ductal Carcinoma in-situ (DCIS), whilst ABS at BASO recommend units develop local guidelines. There are presently no specific guidelines for invasive cancer. We surveyed members of the Association of Breast Surgery (ABS) in order to establish current practice nationally, adherence to NICE guidance and assess whether we are over-treating patients with narrow margins. We hypothesised that larger units may accept narrower excision margins to achieve better cosmesis. Methods: A postal questionnaire was sent to all ABS members in October 2010. This consisted of an internally and externally validated questionnaire about the current practice of the surgeon and their unit. 481 questionnaires were posted in total, all questionnaires returned by 1st February 2011 were analysed. Results: Questionnaire response rate was 60% (281). Surgeons operating on over 50 cancers per year accepted smaller margins than those operating on less than 50 (p<0.02). Acceptable adequate anterior and radial margins ranged from 0-10mm for DCIS and 0-5mm for invasive cancer. A variety of approaches to re-excising anterior margins were reported. Conclusions: This survey suggests that substantial variations exist in current practice with regard to the approach to wide local excision. Operator workload appears to influence what is deemed an acceptable margin. Patients with DCIS are over-treated in some units. These findings support the need to develop national standards for wide local excision.
(*Mann Whitney test) Conclusion: This study has shown that a brief therapeutic hypnosis intervention produced a significant reduction in preoperative anxiety and postoperative pain. This suggests that hypnosis may be a useful adjunct in the preoperative management of patients undergoing surgery for breast cancer. P74. Patient understanding of medical terminology and the role of the Multidisiplinary Team (MDT) in breast cancer care Rebecca Zammit, C. Zammit Brighton and Sussex Universities NHS Trust, Park Centre For Breast Care, 177 Preston Road, Brighton, BN1 6AG Introduction: This study is to assess the lay persons’ understanding of the role of the MDT and common terminology used in the consultation process in breast care. Method: A questionnaire was conducted on lay people (not previous cancer patients). Subjects were asked to define a set of terminologies about the multidisciplinary breast cancer team. Results: Total number of people questioned ¼ 35 Mean age 35 years(range 21-63 years) 60% Female Correct definition for oncologist was in 52%(18/35); 9%(3/35) could define chemotherapy.All could define cancer and surgeon. 74%(26/35) could define radiologist but 42%(15/35) could understand the role of a radiographer. The pathologist’s role, the term Multidisciplinary team and MacMillan were identical at 29%(10/35). Benign was understood by 31%(11/35) and the term receptor by only 3%, though Histology was recognised by 69%(24/35). The term drain was understood by 32%. Conclusions: In the consultation process members of the Multidisciplinary team need to clearly define their role at their first patient encounter. It is a wrong assumption that the job title on a badge is sufficient. Keeping patients well informed about the treatment process is an important element of care that should not be neglected but clear definitions of terms used are required.
P76. The BSG Guideline for Colorectal Adenoma Surveillance: A Need for Review? Ayodeji Odofin The Great Western Hospital, Marlborough Road, Swindon, SN3 6BB Introduction: There is a strong established link between colorectal adenomas (CRA) and the development of colorectal carcinoma (CRC), making the follow up management of colorectal adenomas a significant step in the reduction of the incidence of colorectal carcinoma. This forms the basis for the BSG guideline for the surveillance of colorectal adenomas. The aim of this study is to assess the follow up of patients presenting with CRA at a district general hospital, compare the practice to the BSG guidelines, and determine factors if any mitigating full compliance. Methods: All patients who had CRA on baseline colonic endoscopy between January 2006 and January 2007 were retrospectively reviewed and followed up till January 2011. Data were retrieved from the endosoft pathway and patients notes at the Great Western Hospital. Excluded were patients older than 70, those who had CRC and patients who had resections. Results: 198 patients were analysed with 60 fitting the inclusion criteria. Only 30% of patients were followed up according to the BSG guidelines. The majority of the patients not complying with the guidelines were in the intermediate risk group who had over zealous investigation. Also over investigated were patients who had CRA with moderate to high grade dysplasia. Conclusion: There is need to review the BSG guideline with the aim of incorporating the histological features of CRA into the algorithm, as there is still confusion among practitioners on how best to manage these group of patients P77. Patient satisfaction with breast cancer treatment, cosmesis and body image after surgery Donna Egbeare, K. Shuttlewood, P. King, D. Ferguson Royal Devon and Exeter Foundation NHS Trust, Barrack Road, Exeter, Devon, EX2 5DW
ABSTRACTS
with higher liaison with plastic surgeons. These may influence job planning of breast oncoplastic surgeons in future. P73. Impact of therapeutic hypnosis on pain and anxiety in patients undergoing breast cancer surgery Eamonn Coveney, M. Grieve, B. Kumar Department of Surgery, West Suffolk Hospital NHS Trust, Hardwick Lane, Bury St Edmunds, Suffolk, IP33 2QZ Introduction: Patients undergoing operations for breast cancer frequently experience distress and their recovery can be negatively impacted by a variety of postoperative complications. This study explores the impact of a brief hypnosis intervention on preoperative anxiety and postoperative experience of patients undergoing surgery for breast cancer. Methods: Seventy-seven patients were offered hypnosis on day of admission for breast cancer surgery. Patients choosing hypnosis (n¼39) underwent a 15 minute hypnotic based intervention on the ward where therapeutic suggestions for reduced anxiety, pain, nausea and fatigue were given. Patients were assessed for anxiety on admission and in the anaesthetic room with pain, nausea and fatigue assessed upon discharge using a visual analogue scale (1-100). Results: Hypnosis Control P value* Effect size (meanSD) (meanSD) d Number 39 Ward Anxiety 47 32 Anaesthetic room Anxiety 25 24 Pain 18 16 Nausea 12 24 Fatigue 34 29
38 39 46 30 19 42
24 26 24 32 31
0.0002 0.02 0.17 0.18
0.87 0.22 0.28 0.28
P75. DCIS - do we know what we’re doing? Adam Hassani, C. Griffith, J. Harvey Newcastle-upon-Tyne Hospitals, Royal Victoria Infirmary, Queen Victoria Road, Newcastle-upon-Tyne, NE1 4LP Introduction: Optimal margins for Wide Local Excision have not been clearly established. Larger margins lead to lower recurrence rates but at the expense of cosmetic appearance. NICE guidelines recommend a 2mm margin for Ductal Carcinoma in-situ (DCIS), whilst ABS at BASO recommend units develop local guidelines. There are presently no specific guidelines for invasive cancer. We surveyed members of the Association of Breast Surgery (ABS) in order to establish current practice nationally, adherence to NICE guidance and assess whether we are over-treating patients with narrow margins. We hypothesised that larger units may accept narrower excision margins to achieve better cosmesis. Methods: A postal questionnaire was sent to all ABS members in October 2010. This consisted of an internally and externally validated questionnaire about the current practice of the surgeon and their unit. 481 questionnaires were posted in total, all questionnaires returned by 1st February 2011 were analysed. Results: Questionnaire response rate was 60% (281). Surgeons operating on over 50 cancers per year accepted smaller margins than those operating on less than 50 (p<0.02). Acceptable adequate anterior and radial margins ranged from 0-10mm for DCIS and 0-5mm for invasive cancer. A variety of approaches to re-excising anterior margins were reported. Conclusions: This survey suggests that substantial variations exist in current practice with regard to the approach to wide local excision. Operator workload appears to influence what is deemed an acceptable margin. Patients with DCIS are over-treated in some units. These findings support the need to develop national standards for wide local excision.
(*Mann Whitney test) Conclusion: This study has shown that a brief therapeutic hypnosis intervention produced a significant reduction in preoperative anxiety and postoperative pain. This suggests that hypnosis may be a useful adjunct in the preoperative management of patients undergoing surgery for breast cancer. P74. Patient understanding of medical terminology and the role of the Multidisiplinary Team (MDT) in breast cancer care Rebecca Zammit, C. Zammit Brighton and Sussex Universities NHS Trust, Park Centre For Breast Care, 177 Preston Road, Brighton, BN1 6AG Introduction: This study is to assess the lay persons’ understanding of the role of the MDT and common terminology used in the consultation process in breast care. Method: A questionnaire was conducted on lay people (not previous cancer patients). Subjects were asked to define a set of terminologies about the multidisciplinary breast cancer team. Results: Total number of people questioned ¼ 35 Mean age 35 years(range 21-63 years) 60% Female Correct definition for oncologist was in 52%(18/35); 9%(3/35) could define chemotherapy.All could define cancer and surgeon. 74%(26/35) could define radiologist but 42%(15/35) could understand the role of a radiographer. The pathologist’s role, the term Multidisciplinary team and MacMillan were identical at 29%(10/35). Benign was understood by 31%(11/35) and the term receptor by only 3%, though Histology was recognised by 69%(24/35). The term drain was understood by 32%. Conclusions: In the consultation process members of the Multidisciplinary team need to clearly define their role at their first patient encounter. It is a wrong assumption that the job title on a badge is sufficient. Keeping patients well informed about the treatment process is an important element of care that should not be neglected but clear definitions of terms used are required.
P76. The BSG Guideline for Colorectal Adenoma Surveillance: A Need for Review? Ayodeji Odofin The Great Western Hospital, Marlborough Road, Swindon, SN3 6BB Introduction: There is a strong established link between colorectal adenomas (CRA) and the development of colorectal carcinoma (CRC), making the follow up management of colorectal adenomas a significant step in the reduction of the incidence of colorectal carcinoma. This forms the basis for the BSG guideline for the surveillance of colorectal adenomas. The aim of this study is to assess the follow up of patients presenting with CRA at a district general hospital, compare the practice to the BSG guidelines, and determine factors if any mitigating full compliance. Methods: All patients who had CRA on baseline colonic endoscopy between January 2006 and January 2007 were retrospectively reviewed and followed up till January 2011. Data were retrieved from the endosoft pathway and patients notes at the Great Western Hospital. Excluded were patients older than 70, those who had CRC and patients who had resections. Results: 198 patients were analysed with 60 fitting the inclusion criteria. Only 30% of patients were followed up according to the BSG guidelines. The majority of the patients not complying with the guidelines were in the intermediate risk group who had over zealous investigation. Also over investigated were patients who had CRA with moderate to high grade dysplasia. Conclusion: There is need to review the BSG guideline with the aim of incorporating the histological features of CRA into the algorithm, as there is still confusion among practitioners on how best to manage these group of patients P77. Patient satisfaction with breast cancer treatment, cosmesis and body image after surgery Donna Egbeare, K. Shuttlewood, P. King, D. Ferguson Royal Devon and Exeter Foundation NHS Trust, Barrack Road, Exeter, Devon, EX2 5DW