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Family history: Breast cancer risk evaluation tools
ABSTRACTS Results: 80% of tumours were fully excised at the first operation. Those patients who required re-excision had a smaller radial margin at initial operation than those who didn’t need repeat surgery. However, this difference was not significant (p¼0.103). 33% of women in the study did not undergo re-excision despite having a margin of <5mm. Conclusion: Further controlled trials are needed to elicit optimum resection margins in WLE surgery. There may be ethical and practical contraindications to carrying out this research. Currently, the decision to reexcise is dependent on clinical judgement. http://dx.doi.org/10.1016/j.ejso.2013.01.220
P185. 23hr model for breast cancer patients e Development of the BCN service and patient pathway Sue Frost, Amanda Jones, Helen Taylor, Marcia Berry, Geraldine Sheridan Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK Sandwell and West Birmingham Hospitals NHS Trust have been the lead in developing day case/23hr inpatient stay pathway for non reconstructive breast surgery over the past 7yrs. 2011 National finalists in Nursing Times awards 2012 National Winners of Workforce Efficiency Award in Annual Health Service Journal awards. There has been a wealth of presentations and posters raising the profile of the development of this service but have focused on the medical model. This poster focuses on the impact this vital developing practice has on the role of the BCN, their workload and more importantly how this has helped to streamline the patient pathway and reduce their hospital stay. It describes the changes to our service and our practices that enabled us to achieve our goal of day case / 23hr stay for our patient undergoing nonreconstructive surgery. Key areas for change within the BCN service were within pre-admission clinic and restructuring the discharge process Changing the way we support our patients has not resulted in any increased workload, merely moved the focus. A more comprehensive assessment earlier in the pathway reduces the workload overall and allows more holistic discussions and support for patients. http://dx.doi.org/10.1016/j.ejso.2013.01.221
P187. Early Experience of consenting patients to donate to a breast cancer tissue bank Rona Gooda, Valerie Speirsa, Andrew M. Hanbya, Kieran Horganb a University of Leeds, Leeds, UK b Leeds Teaching Hospitals Trust, Leeds, UK
Introduction: Tissue banking of breast cancer samples is a valuable resource in facilitating important scientific and translational research and exploring new therapeutic strategies. Little is known about patients’ attitudes to consent for banking as the facilities have been confined to a small number of centres. Methods: Following local REC approval; reference 09/H1306/108, we opened our tissue bank as one of 4 national centres in February 2010 and commenced approaching patients at our breast clinic. Results: Over a two and a half year period 966 patients who were planned for breast surgery at our centre were approached. 892 consented to tissue banking and 873 to both tissue and blood. 92% patients advised they were happy to donate. Asian patients were less likely to consent while younger patients did not like to donate blood. All male patients consented to tissue and blood storage.
513 Conclusions: Early experience was encouraging, patients overall were very enthusiastic and willing to assist. More research is needed to understand the barriers in preventing ethnic minorities to donate and in young people for blood samples. http://dx.doi.org/10.1016/j.ejso.2013.01.223
P188. The NHS breast screening programme: How to improve the service from a customer’s perspective Victoria Harmer Imperial College Healthcare NHS Trust, London, UK
Introduction: Although the NHS Breast Screening Programme has been a service provided since 1988, it is important what is offered is what users want. Thus it is necessary we understand patients’ perceptions of how the service can be improved. Are we providing what is wanted in a breast screening programme? Methods: Preliminary interviews took place with 6 women who had attended screening to identify salient points and to form the basis of a questionnaire. This questionnaire was used on a sample (n¼25) of women and the results analyzed. Results:
60% did not mind where they were screened (hospital/mobile) 48% would prefer a choice of location 20% would like evening/weekend appointments 8% preference for appointment the same month every 3 years a fixed appointment was preferred 44% were happy to leave their clothes in the changing cubicle while being screened main disadvantage was pain and cold feel of the machine main ‘like’ was service efficiency 52% thought women did not attend due to ignorance and fear Suggest a comments box Conclusion
Mobility ramp needed for mobile units e stairs near impossible for some Provide a choice of venues e.g. hospital and mobile unit Offer some evening and week-end appointments Ancillary staff to go on a communications study day Use a comments box Have information on screening in non-threatening places e.g. chemists http://dx.doi.org/10.1016/j.ejso.2013.01.224
P189. Family history: Breast cancer risk evaluation tools Angela Duckworth, Barbara Seddon Bolton NHS Foundation Trust, Bolton, UK
Introduction: Cancer risk assessment is a calculation of an individual’s risk based on their family history. We aimed to compare the outcomes from 2 different risk assessment tools (Tyrer-Cuzick v Claus) when predicting a woman’s lifetime risk of breast cancer. This would illustrate the strengths and limitations of both risk models when compared. We used as our standards: NICE Clinical Guideline 41: Familial Breast Cancer (October 2006) Consent and Confidentiality in Clinical Genetic Practice: guidance on genetic testing and sharing genetic information (Joint Committee on Medical Genetics, September 2011)
514 Method: All patients who were booked to attend for a family history consultation within a six month period of April e October 2012 were audited (n¼55). The data collected at the initial consultation was input in to the Tyrer-Cuzick electronic programme and the results then compared to those recorded at patient interview using the Claus Tables. Results: Of 55 patients: 6 did not attend and 4 case notes were missing (sample n¼45). There were 14 (31.1%) notable differences in outcomes; 2 (4.4%) unable to calculate with Claus and 29 (64.4%) producing similar results. 1 out of the 14 had been discharged but the audit had shown a need for annual screening. The remaining 13 received screening/ were discharged appropriately based on the additional information presented at interview. Conclusion: Claus model alone did not equate to Tyrer-Cuzick but with additional information given at interview, the outcomes matched. Audit to continue for comparison in 6 months. http://dx.doi.org/10.1016/j.ejso.2013.01.225
P190. Improving the standards of care for patients with secondary breast cancer in Bradford, West Yorkshire Lorraine Newton, Mandy Blackburn Bradford Teaching Hospitals, Bradford. West Yorkshire, UK
The provision of structured nursing support to patients with Secondary Breast Cancer is described as inadequate in a cross sectional survey of 276 breast care nurses in the United Kingdom (1). A national coalition taskforce examining service delivery (2) published a framework of standards to improve the support offered to patients living with secondary cancer (3). An audit of 26 patients attending the oncology department for treatment of metastatic breast cancer was carried out in the form of
ABSTRACTS a questionnaire examining the current provision of physical, psychological, social and financial support. Whilst patients reported a high level of satisfaction with their oncologist and treatment plan, a need for access to nursing support, written information and financial support was identified. Improvements made in service provision: 1. Specialist Nurses have re-organised their clinical workload to provide weekly support to the oncology clinic and are present when a diagnosis of metastatic disease is discussed. Offering continuing support and information. 2. Open evenings were held with presentations from Palliative care and Oncology team to raise awareness about how these services enhance and complement treatment through collaborative working partnerships. 3. A Time Out day to the Haven in Leeds enabled patients to share experiences and access complementary therapy treatments. The response from patients to these developments has been very positive and encouraging. 1. Reed, E.Scanlon K. Fenlon, D. (2010) European Journal of Cancer Care 19:5. 2. Breast Cancer Care Secondary Taskforce (2008) Improving the Care of people with Metastatic Breast Cancer. 3. Breast Cancer Care (2009). Standards of Care for people with Secondary Breast Cancer. http://dx.doi.org/10.1016/j.ejso.2013.01.226
P185. 23hr model for breast cancer patients e Development of the BCN service and patient pathway Sue Frost, Amanda Jones, Helen Taylor, Marcia Berry, Geraldine Sheridan Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK Sandwell and West Birmingham Hospitals NHS Trust have been the lead in developing day case/23hr inpatient stay pathway for non reconstructive breast surgery over the past 7yrs. 2011 National finalists in Nursing Times awards 2012 National Winners of Workforce Efficiency Award in Annual Health Service Journal awards. There has been a wealth of presentations and posters raising the profile of the development of this service but have focused on the medical model. This poster focuses on the impact this vital developing practice has on the role of the BCN, their workload and more importantly how this has helped to streamline the patient pathway and reduce their hospital stay. It describes the changes to our service and our practices that enabled us to achieve our goal of day case / 23hr stay for our patient undergoing nonreconstructive surgery. Key areas for change within the BCN service were within pre-admission clinic and restructuring the discharge process Changing the way we support our patients has not resulted in any increased workload, merely moved the focus. A more comprehensive assessment earlier in the pathway reduces the workload overall and allows more holistic discussions and support for patients. http://dx.doi.org/10.1016/j.ejso.2013.01.221
P187. Early Experience of consenting patients to donate to a breast cancer tissue bank Rona Gooda, Valerie Speirsa, Andrew M. Hanbya, Kieran Horganb a University of Leeds, Leeds, UK b Leeds Teaching Hospitals Trust, Leeds, UK
Introduction: Tissue banking of breast cancer samples is a valuable resource in facilitating important scientific and translational research and exploring new therapeutic strategies. Little is known about patients’ attitudes to consent for banking as the facilities have been confined to a small number of centres. Methods: Following local REC approval; reference 09/H1306/108, we opened our tissue bank as one of 4 national centres in February 2010 and commenced approaching patients at our breast clinic. Results: Over a two and a half year period 966 patients who were planned for breast surgery at our centre were approached. 892 consented to tissue banking and 873 to both tissue and blood. 92% patients advised they were happy to donate. Asian patients were less likely to consent while younger patients did not like to donate blood. All male patients consented to tissue and blood storage.
513 Conclusions: Early experience was encouraging, patients overall were very enthusiastic and willing to assist. More research is needed to understand the barriers in preventing ethnic minorities to donate and in young people for blood samples. http://dx.doi.org/10.1016/j.ejso.2013.01.223
P188. The NHS breast screening programme: How to improve the service from a customer’s perspective Victoria Harmer Imperial College Healthcare NHS Trust, London, UK
Introduction: Although the NHS Breast Screening Programme has been a service provided since 1988, it is important what is offered is what users want. Thus it is necessary we understand patients’ perceptions of how the service can be improved. Are we providing what is wanted in a breast screening programme? Methods: Preliminary interviews took place with 6 women who had attended screening to identify salient points and to form the basis of a questionnaire. This questionnaire was used on a sample (n¼25) of women and the results analyzed. Results:
60% did not mind where they were screened (hospital/mobile) 48% would prefer a choice of location 20% would like evening/weekend appointments 8% preference for appointment the same month every 3 years a fixed appointment was preferred 44% were happy to leave their clothes in the changing cubicle while being screened main disadvantage was pain and cold feel of the machine main ‘like’ was service efficiency 52% thought women did not attend due to ignorance and fear Suggest a comments box Conclusion
Mobility ramp needed for mobile units e stairs near impossible for some Provide a choice of venues e.g. hospital and mobile unit Offer some evening and week-end appointments Ancillary staff to go on a communications study day Use a comments box Have information on screening in non-threatening places e.g. chemists http://dx.doi.org/10.1016/j.ejso.2013.01.224
P189. Family history: Breast cancer risk evaluation tools Angela Duckworth, Barbara Seddon Bolton NHS Foundation Trust, Bolton, UK
Introduction: Cancer risk assessment is a calculation of an individual’s risk based on their family history. We aimed to compare the outcomes from 2 different risk assessment tools (Tyrer-Cuzick v Claus) when predicting a woman’s lifetime risk of breast cancer. This would illustrate the strengths and limitations of both risk models when compared. We used as our standards: NICE Clinical Guideline 41: Familial Breast Cancer (October 2006) Consent and Confidentiality in Clinical Genetic Practice: guidance on genetic testing and sharing genetic information (Joint Committee on Medical Genetics, September 2011)
514 Method: All patients who were booked to attend for a family history consultation within a six month period of April e October 2012 were audited (n¼55). The data collected at the initial consultation was input in to the Tyrer-Cuzick electronic programme and the results then compared to those recorded at patient interview using the Claus Tables. Results: Of 55 patients: 6 did not attend and 4 case notes were missing (sample n¼45). There were 14 (31.1%) notable differences in outcomes; 2 (4.4%) unable to calculate with Claus and 29 (64.4%) producing similar results. 1 out of the 14 had been discharged but the audit had shown a need for annual screening. The remaining 13 received screening/ were discharged appropriately based on the additional information presented at interview. Conclusion: Claus model alone did not equate to Tyrer-Cuzick but with additional information given at interview, the outcomes matched. Audit to continue for comparison in 6 months. http://dx.doi.org/10.1016/j.ejso.2013.01.225
P190. Improving the standards of care for patients with secondary breast cancer in Bradford, West Yorkshire Lorraine Newton, Mandy Blackburn Bradford Teaching Hospitals, Bradford. West Yorkshire, UK
The provision of structured nursing support to patients with Secondary Breast Cancer is described as inadequate in a cross sectional survey of 276 breast care nurses in the United Kingdom (1). A national coalition taskforce examining service delivery (2) published a framework of standards to improve the support offered to patients living with secondary cancer (3). An audit of 26 patients attending the oncology department for treatment of metastatic breast cancer was carried out in the form of
ABSTRACTS a questionnaire examining the current provision of physical, psychological, social and financial support. Whilst patients reported a high level of satisfaction with their oncologist and treatment plan, a need for access to nursing support, written information and financial support was identified. Improvements made in service provision: 1. Specialist Nurses have re-organised their clinical workload to provide weekly support to the oncology clinic and are present when a diagnosis of metastatic disease is discussed. Offering continuing support and information. 2. Open evenings were held with presentations from Palliative care and Oncology team to raise awareness about how these services enhance and complement treatment through collaborative working partnerships. 3. A Time Out day to the Haven in Leeds enabled patients to share experiences and access complementary therapy treatments. The response from patients to these developments has been very positive and encouraging. 1. Reed, E.Scanlon K. Fenlon, D. (2010) European Journal of Cancer Care 19:5. 2. Breast Cancer Care Secondary Taskforce (2008) Improving the Care of people with Metastatic Breast Cancer. 3. Breast Cancer Care (2009). Standards of Care for people with Secondary Breast Cancer. http://dx.doi.org/10.1016/j.ejso.2013.01.226