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P105. Evolution of trends in breast reconstruction in a tertiary referral centre
S56 Introduction: SentiMag is a new system for the detection of the sentinel lymph node (SLN) in patients with breast cancer. The new technique uses 2 devices: a subcutaneous injection of a magnetic tracer into the breast and the use of a hand-held device (a magnetometer) to detect the SLN intra-operatively. We used SentiMag and compared it to the standard technique (radioisotope alone in our unit) used in breast cancer patients. We looked at the localisation rate of SLN detected with both the standard and the SentiMag technique. Methods: We prospectively collected and analysed data from 22 patients listed for SLN biopsy for which we used both the SentiMag and the standard radioisotope as employed in our unit. Results: Age 37e78 years Tumour size on imaging 8mme48mm (Mean 17.35mm) Time of injection to start of surgery 7mine46 min (Mean 22.7 min) Pre-operative Sentimag hot spot in 14 (64%) patients Pre-operative Gamma probe hot spot 20 (91%) patients Final detection rate for SentiMag in our group of patients was 12/22 (55%) Conclusions: SentiMag had a detection rate of 55% compared to 95% of the standard technique. Nodes were only identified by change in colour and increased signal in 5/22 patients using the SentiMag technique. The size of the axillary incision was larger when using the SentiMag as compared to the standard technique. In our group of patients it was observed that even after harvesting the SLN there was still an increased signal in the axilla when using the SentiMag probe. http://dx.doi.org/10.1016/j.ejso.2015.03.141
P104. Use of medical terminology. Are we talking too much jargon to patients? Rachel O’Connell, Roger Stevens, Komel Khabra, Jennifer Rusby The Royal Marsden NHS Foundation Trust, Sutton, UK
ABSTRACTS P105. Evolution of trends in breast reconstruction in a tertiary referral centre Niamh O’ Halloran, Aoife Lowery, Karl Sweeney, Carmel Malone, Padraic Regan, Alan Hussey, Michael Kerin Galway University Hospital, Galway, Ireland Introduction: Breast reconstruction is an important component of multidisciplinary breast care, affording clearly defined psychosocial and aesthetic benefits to women undergoing mastectomy. Evolving practice has resulted in an increasing range of reconstructive options available to breast cancer patients. The aim of this study was to examine the practice of breast reconstruction over the last decade at a specialist tertiary referral Breast Cancer Centre. Methods: A prospectively maintained breast cancer database was reviewed to collate data on all patients who underwent breast reconstruction between 2004 and 2014. Data on patient demographics, mastectomies, breast reconstruction timing and technique were analysed. Results: 546 (56.28%) of 970 patients who underwent mastectomy had a breast reconstruction. 90.5% of breast reconstructions were immediate. There was a marked increase in breast reconstruction rates from 13 (17.57%) in 2004 to 68 (46%) in 2013. 19.57% of breast reconstructions were performed by plastic surgeons and 80.43% by oncoplastic surgeons. Reconstructive techniques included: Implant (28%), LD (62%) DIEP (7%), TRAM (3%). There has been an increase in the % of implant based reconstructions in recent years, compared to LD flaps, which comprised 88% of reconstructions performed in the first 5 years of the series compared to only 41% in the latter 5 years. The age of patients undergoing reconstruction ranged from 21 to 86 years, however the mean age of patients undergoing mastectomy and reconstruction (46.64 years) was significantly lower than mastectomy alone (62.99 years). Conclusion: In conclusion breast reconstruction rates are increasing with a transition of recent trends toward immediate implant-based reconstruction. http://dx.doi.org/10.1016/j.ejso.2015.03.143
Aims: Patients’ understanding of their medical problems is essential. Information must be conveyed in a comprehensible manner to facilitate informed decision-making and consent, compliance with treatment and reduction of anxiety. In this study, we sought to evaluate patients’ understanding of common terms used by breast surgeons in order to identify words which may need to be defined and explained during a clinic consultation. Methods: A written questionnaire was given to all new patients in the waiting area prior to their breast clinic consultation during a six week period. Patients were asked to define twelve medical terms which are commonly used. The questionnaires were reviewed by two independent assessors with each question given an outcome of correct, partially correct, incorrect or blank. Any discrepancy in outcome between the examiners was discussed to gain consensus for a final outcome for each question. Results: 102 consecutive patients were given the questionnaire; 7 declined or were unable to complete it. Of those who completed the questionnaire the mean age was 46.8 years (range, 16e90), 87 (91%) were female and 85 (98%) spoke English as their first language. 88% defined ‘Surgeon’ correctly whereas ‘Radiographer’ and ‘Radiologist’ were correctly defined by only 19% and 29% respectively with many confusing the two roles. 26% correctly defined ‘Pathologist’ and 41% ‘Oncologist’. Two-thirds of patients correctly defined ‘Benign’ (66%) and ‘Malignant’ (65%). ‘Mammogram’ and ‘Ultrasound’ were correctly defined by 39% and 8% respectively. 21% of patients correctly defined ‘Multi-Disciplinary Team Meeting’. 1 in 5 patients correctly defined ‘Chemotherapy’ (20%) and ‘Radiotherapy’ (19%). Conclusions: This study has identified that many of the medical terms used in a consultation are not understood by patients. To provide optimal care, it is important for doctors to communicate clearly with patients and ensure medical terms are fully understood throughout the treatment process. Education must be incorporated as a routine part of the consultation to enhance the patient experience and ensure they can actively participate in making informed decisions about their care. http://dx.doi.org/10.1016/j.ejso.2015.03.142
P106. Low Risk Breast Clinics: An alternative to One-Stop Clinics for a selected patient group David Anderson, Michael McKirdy Royal Alexandra Hospital, Paisley, UK Introduction: Breast Cancer is the leading cause of female cancer worldwide, causing 29% of new female cancers in Scotland with lifetime risk 11.6%. With priority on prompt referral/specialist review, pressure on the breast service is high. We aim to demonstrate that “Low Risk” Breast Clinics provide a useful alternative to Triple Assessment clinics, and their utilisation is effective in reducing strain on the breast service. Methods: Low Risk Clinic without radiology was created, where patients unlikely to have breast cancer were reviewed. Low Risk deemed as 1) Female aged <35; 2) Any symptom other than discreet lump; 3) Male Retrospective analysis for all attendees (n ¼ 458), MarcheDecember 2014. All attendees included. Analysis of age, urgency, symptoms, clinical findings, need for imaging/biopsy, diagnosis and outcome for all 458 patients. Data was analysed and clinic efficacy evaluated. Results: 458 patients (F ¼ 448 M ¼ 12). 427 (93.23%) fit low risk criteria. Most common referral symptom: pain (n ¼ 221, 48.25%) Most common diagnosis: No abnormality (n ¼ 159, 34.72%) 77 (16.81%) required imaging and 21 (4.59%) biopsy. 384 (83.84%) discharged at first appointment, 6 (1.31%) discharged with referral to other speciality, 14 (3.06%) for family history screening, giving a total of 404 Patients (88.21%) not requiring triple assessment or further appointment. Only 3 (0.66%) cancer diagnoses: none fit low risk criteria. Conclusion: Low Risk Clinics provide a viable alternative to triple assessment, with high discharge at first attendance and low need for imaging/biopsy. They allow greater flexibility in clinic timing and can relieve
P104. Use of medical terminology. Are we talking too much jargon to patients? Rachel O’Connell, Roger Stevens, Komel Khabra, Jennifer Rusby The Royal Marsden NHS Foundation Trust, Sutton, UK
ABSTRACTS P105. Evolution of trends in breast reconstruction in a tertiary referral centre Niamh O’ Halloran, Aoife Lowery, Karl Sweeney, Carmel Malone, Padraic Regan, Alan Hussey, Michael Kerin Galway University Hospital, Galway, Ireland Introduction: Breast reconstruction is an important component of multidisciplinary breast care, affording clearly defined psychosocial and aesthetic benefits to women undergoing mastectomy. Evolving practice has resulted in an increasing range of reconstructive options available to breast cancer patients. The aim of this study was to examine the practice of breast reconstruction over the last decade at a specialist tertiary referral Breast Cancer Centre. Methods: A prospectively maintained breast cancer database was reviewed to collate data on all patients who underwent breast reconstruction between 2004 and 2014. Data on patient demographics, mastectomies, breast reconstruction timing and technique were analysed. Results: 546 (56.28%) of 970 patients who underwent mastectomy had a breast reconstruction. 90.5% of breast reconstructions were immediate. There was a marked increase in breast reconstruction rates from 13 (17.57%) in 2004 to 68 (46%) in 2013. 19.57% of breast reconstructions were performed by plastic surgeons and 80.43% by oncoplastic surgeons. Reconstructive techniques included: Implant (28%), LD (62%) DIEP (7%), TRAM (3%). There has been an increase in the % of implant based reconstructions in recent years, compared to LD flaps, which comprised 88% of reconstructions performed in the first 5 years of the series compared to only 41% in the latter 5 years. The age of patients undergoing reconstruction ranged from 21 to 86 years, however the mean age of patients undergoing mastectomy and reconstruction (46.64 years) was significantly lower than mastectomy alone (62.99 years). Conclusion: In conclusion breast reconstruction rates are increasing with a transition of recent trends toward immediate implant-based reconstruction. http://dx.doi.org/10.1016/j.ejso.2015.03.143
Aims: Patients’ understanding of their medical problems is essential. Information must be conveyed in a comprehensible manner to facilitate informed decision-making and consent, compliance with treatment and reduction of anxiety. In this study, we sought to evaluate patients’ understanding of common terms used by breast surgeons in order to identify words which may need to be defined and explained during a clinic consultation. Methods: A written questionnaire was given to all new patients in the waiting area prior to their breast clinic consultation during a six week period. Patients were asked to define twelve medical terms which are commonly used. The questionnaires were reviewed by two independent assessors with each question given an outcome of correct, partially correct, incorrect or blank. Any discrepancy in outcome between the examiners was discussed to gain consensus for a final outcome for each question. Results: 102 consecutive patients were given the questionnaire; 7 declined or were unable to complete it. Of those who completed the questionnaire the mean age was 46.8 years (range, 16e90), 87 (91%) were female and 85 (98%) spoke English as their first language. 88% defined ‘Surgeon’ correctly whereas ‘Radiographer’ and ‘Radiologist’ were correctly defined by only 19% and 29% respectively with many confusing the two roles. 26% correctly defined ‘Pathologist’ and 41% ‘Oncologist’. Two-thirds of patients correctly defined ‘Benign’ (66%) and ‘Malignant’ (65%). ‘Mammogram’ and ‘Ultrasound’ were correctly defined by 39% and 8% respectively. 21% of patients correctly defined ‘Multi-Disciplinary Team Meeting’. 1 in 5 patients correctly defined ‘Chemotherapy’ (20%) and ‘Radiotherapy’ (19%). Conclusions: This study has identified that many of the medical terms used in a consultation are not understood by patients. To provide optimal care, it is important for doctors to communicate clearly with patients and ensure medical terms are fully understood throughout the treatment process. Education must be incorporated as a routine part of the consultation to enhance the patient experience and ensure they can actively participate in making informed decisions about their care. http://dx.doi.org/10.1016/j.ejso.2015.03.142
P106. Low Risk Breast Clinics: An alternative to One-Stop Clinics for a selected patient group David Anderson, Michael McKirdy Royal Alexandra Hospital, Paisley, UK Introduction: Breast Cancer is the leading cause of female cancer worldwide, causing 29% of new female cancers in Scotland with lifetime risk 11.6%. With priority on prompt referral/specialist review, pressure on the breast service is high. We aim to demonstrate that “Low Risk” Breast Clinics provide a useful alternative to Triple Assessment clinics, and their utilisation is effective in reducing strain on the breast service. Methods: Low Risk Clinic without radiology was created, where patients unlikely to have breast cancer were reviewed. Low Risk deemed as 1) Female aged <35; 2) Any symptom other than discreet lump; 3) Male Retrospective analysis for all attendees (n ¼ 458), MarcheDecember 2014. All attendees included. Analysis of age, urgency, symptoms, clinical findings, need for imaging/biopsy, diagnosis and outcome for all 458 patients. Data was analysed and clinic efficacy evaluated. Results: 458 patients (F ¼ 448 M ¼ 12). 427 (93.23%) fit low risk criteria. Most common referral symptom: pain (n ¼ 221, 48.25%) Most common diagnosis: No abnormality (n ¼ 159, 34.72%) 77 (16.81%) required imaging and 21 (4.59%) biopsy. 384 (83.84%) discharged at first appointment, 6 (1.31%) discharged with referral to other speciality, 14 (3.06%) for family history screening, giving a total of 404 Patients (88.21%) not requiring triple assessment or further appointment. Only 3 (0.66%) cancer diagnoses: none fit low risk criteria. Conclusion: Low Risk Clinics provide a viable alternative to triple assessment, with high discharge at first attendance and low need for imaging/biopsy. They allow greater flexibility in clinic timing and can relieve