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P57. Audit of restaging CT scans for rectal cancer patients after chemoradiotherapy
ABSTRACTS P54. Non-melanoma skin cancer incomplete excision rates of different grades of plastic surgeons and the implications for service provision Kai Yuen Wong, Onur Gilleard, Richard Price Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
1121 2 Centre of Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
Background: When non-melanoma skin cancer excision margins are involved, the recommendation is usually for re-excision, radiotherapy or close outpatient follow-up. All of these have a negative effect on patient experience and incur additional financial costs. In an era where demand is increasing on limited resources and risk-adjusted clinical performance data is used to allocate funding to departments and trusts, significant differences in incomplete excision rates between grades of surgeons may have a significant bearing on future skin cancer service provision. In a retrospective study, we compared non-melanoma skin cancer incomplete excision rates of consultants versus trainees for procedures performed in the outpatient clinic setting. Methods: We analysed 889 histopathologically confirmed basal cell carcinoma or squamous cell carcinoma excisions performed from 1 January 2009 to 31 December 2009 at the plastic surgery departments of two hospitals. Fisher’s exact test was also used to analyse the rates of incomplete excision in specific anatomical locations. Results: There was a significant difference (p<0.01) in the non-melanoma skin cancer incomplete excision rate between consultants (4.1%) and trainees (8.7%). Subgrouping lesions according to anatomical site showed that the difference in incomplete excision rates was most marked for those lesions arising in the head and neck region. Conclusion: In order to reduce incomplete excision rates in a feasible and cost effective manner, we suggest that lesions arising in these anatomical sites are excised by consultants or under close consultant supervision.
Introduction: Mammographic screening reduces breast cancer mortality, although the upper age at which risks outweigh benefits is unclear. Self-referral rates for mammography over 70 years are low and based on poor understanding of risks and benefits. Uptake may be facilitated by improved patient awareness and informational support. The first stage in developing such support is to explore the information needs of older women (>70) and health care providers (HCPs). Methods: Qualitative interviews were conducted with HCPs (breast/elderly care) and women >70 years. Interviews discontinued once saturation of themes occurred. A questionnaire was constructed from interview findings and distributed to women >70 years. Results: 23 HCPs and 19 older women (age range 71-84 years) were interviewed. HCPs felt access to screening should be based on full analysis of risks and benefits. 45 of 99 questionnaires were returned (45% response rate). Only 24% (10/42) were aware that breast cancer risk increases with age with 67% (30/45) aware of self-referral service for screening. Leaflets (69%; 31/45) sent by post (98%; 44/45) with risk information as a proportion (47%; 21/45) were favoured. GPs were the preferred source (60%; 27/ 45). Desired content included age-specific incidence (73%; 33/45), local contact details (78%; 35/45) and opening times (69%; 31/45). Conclusions: Further work developing informational support for selfreferral for screening >70 years should focus on leaflets and include practical information on how to access local services as well as risk-benefit ratio. Risk information should be portrayed as a proportion. Dissemination should be through GP surgeries and by post.
P55. Media publicity surrounding ‘Poly Implant Prosthese’ breast implants: Rupture rates and the impact on breast cancer services Rachael Olivia Forsythe, Zenon Rayter University Hospitals Bristol NHS Foundation Trust, Bristol, UK
P57. Audit of restaging CT scans for rectal cancer patients after chemoradiotherapy Elizabeth Li, Dermot Burke Leeds Teaching Hospital Trust, Leeds, UK
Introduction: Since December 2011, there has been concern that the use of non-medical grade silicone ‘Poly Implant Prosthese’ (PIP) implants may be associated with higher rupture rates. It is estimated that up to 50,000 women in the UK have PIP implants; thousands have attended NHS services for evaluation. The actual rupture rate is not yet known. Methods: We carried out a prospective study of all patients with PIP implants seen in the Breast Surgery Out-patient Clinic (BSOPC) at Bristol Royal Infirmary (BRI) between January and April 2012 (n¼55). We collected data on symptoms, clinical and ultrasound findings. We also reviewed referral rates and use of fast-track services. Results: At the time of submission, data was available for 46 patients. 35 patients (76.1%) were symptomatic. Ultrasound detected 13 (28.2%) patients with implant rupture, 2 of which were asymptomatic. The symptom presentation correlated with the side of implant rupture in 7 patients (53.8%). The number of referrals to BSOPC increased to 752, in comparison to the same time period in 2011 and 2010 (698 and 630) and constituted nearly 7% of new referrals. The median time from referral to clinic was 21.5 days. Conclusion: In our study, 28.2% patients demonstrated ultrasound evidence of implant rupture. This did not always correlate with symptoms or clinical findings. PIP referrals constituted nearly 7% of new referrals to the BSOPC, increasing service workload. Further studies are required to evaluate the rupture rate of silicone breast implants and the impact of the ‘PIP scandal’ on NHS services.
Introduction: Patients with locally advanced primary rectal cancers receive long course chemo-radiotherapy (LCRT) to the primary tumour to facilitate surgery. Regional guidelines recommend that CT scans be performed both before and after CRT to determine the extent of distant metastases and consequently the appropriateness of radical curative surgery. This audit assessed the influence of a second staging CT post LCRT upon the decision to operate. Methods: All patients with a potentially curable primary rectal cancer who received LCRT between 01/01/06 e 21/12/2011 were identified from the Trust’s database. Timing of CT scans, MRIs, pathology reports, details of surgical interventions and clinical decisions were collected. Results: 138 patients were identified (Male 92, Female 46), median age 65.4y (23.9-85.0). Thirty-seven (27%) patients had distal metastases on 1st CT. Of these, 33% had further metastatic disease on the 2nd CT scan. However, 28 (76%) still had excisional rectal surgery. On the 2nd, post-LCRT CT, 25 patients (18%) had developed new metastatic disease, of whom 13 still proceeded to excisional rectal surgery. In 15 patients (11%) there was a change in the management as a result of the post-LCRT scan. In 8 patients this was due to progression of local disease on MRI, in 7 due to progression of distal disease on CT, in 3 of whom this was metastatic from a non-rectal primary. Conclusions: In patients with locally advanced rectal cancer, the postLCRT CT scan adds little information, changing management in 5% of patients. MRI scan of the rectal cancer alone is sufficient.
P56. Helping older women make informed choices about breast screening Harriet Walker1, Karen Collins2, Yvonne Cooper2, Malcolm Reed1, Lynda Wyld1 1 Academic unit of Surgical Oncology, University of Sheffield, Sheffield, UK
P58. The quality and readability of colorectal cancer information on the internet Swethan Alagaratnam, Perbinder Grewal, Santosh Somasundaram, Georgios Akritidis, Salvatore Guarino, Marc Winslet Department of Colorectal Surgery, Royal Free Hampstead NHS Foundation Trust, London, UK
1121 2 Centre of Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
Background: When non-melanoma skin cancer excision margins are involved, the recommendation is usually for re-excision, radiotherapy or close outpatient follow-up. All of these have a negative effect on patient experience and incur additional financial costs. In an era where demand is increasing on limited resources and risk-adjusted clinical performance data is used to allocate funding to departments and trusts, significant differences in incomplete excision rates between grades of surgeons may have a significant bearing on future skin cancer service provision. In a retrospective study, we compared non-melanoma skin cancer incomplete excision rates of consultants versus trainees for procedures performed in the outpatient clinic setting. Methods: We analysed 889 histopathologically confirmed basal cell carcinoma or squamous cell carcinoma excisions performed from 1 January 2009 to 31 December 2009 at the plastic surgery departments of two hospitals. Fisher’s exact test was also used to analyse the rates of incomplete excision in specific anatomical locations. Results: There was a significant difference (p<0.01) in the non-melanoma skin cancer incomplete excision rate between consultants (4.1%) and trainees (8.7%). Subgrouping lesions according to anatomical site showed that the difference in incomplete excision rates was most marked for those lesions arising in the head and neck region. Conclusion: In order to reduce incomplete excision rates in a feasible and cost effective manner, we suggest that lesions arising in these anatomical sites are excised by consultants or under close consultant supervision.
Introduction: Mammographic screening reduces breast cancer mortality, although the upper age at which risks outweigh benefits is unclear. Self-referral rates for mammography over 70 years are low and based on poor understanding of risks and benefits. Uptake may be facilitated by improved patient awareness and informational support. The first stage in developing such support is to explore the information needs of older women (>70) and health care providers (HCPs). Methods: Qualitative interviews were conducted with HCPs (breast/elderly care) and women >70 years. Interviews discontinued once saturation of themes occurred. A questionnaire was constructed from interview findings and distributed to women >70 years. Results: 23 HCPs and 19 older women (age range 71-84 years) were interviewed. HCPs felt access to screening should be based on full analysis of risks and benefits. 45 of 99 questionnaires were returned (45% response rate). Only 24% (10/42) were aware that breast cancer risk increases with age with 67% (30/45) aware of self-referral service for screening. Leaflets (69%; 31/45) sent by post (98%; 44/45) with risk information as a proportion (47%; 21/45) were favoured. GPs were the preferred source (60%; 27/ 45). Desired content included age-specific incidence (73%; 33/45), local contact details (78%; 35/45) and opening times (69%; 31/45). Conclusions: Further work developing informational support for selfreferral for screening >70 years should focus on leaflets and include practical information on how to access local services as well as risk-benefit ratio. Risk information should be portrayed as a proportion. Dissemination should be through GP surgeries and by post.
P55. Media publicity surrounding ‘Poly Implant Prosthese’ breast implants: Rupture rates and the impact on breast cancer services Rachael Olivia Forsythe, Zenon Rayter University Hospitals Bristol NHS Foundation Trust, Bristol, UK
P57. Audit of restaging CT scans for rectal cancer patients after chemoradiotherapy Elizabeth Li, Dermot Burke Leeds Teaching Hospital Trust, Leeds, UK
Introduction: Since December 2011, there has been concern that the use of non-medical grade silicone ‘Poly Implant Prosthese’ (PIP) implants may be associated with higher rupture rates. It is estimated that up to 50,000 women in the UK have PIP implants; thousands have attended NHS services for evaluation. The actual rupture rate is not yet known. Methods: We carried out a prospective study of all patients with PIP implants seen in the Breast Surgery Out-patient Clinic (BSOPC) at Bristol Royal Infirmary (BRI) between January and April 2012 (n¼55). We collected data on symptoms, clinical and ultrasound findings. We also reviewed referral rates and use of fast-track services. Results: At the time of submission, data was available for 46 patients. 35 patients (76.1%) were symptomatic. Ultrasound detected 13 (28.2%) patients with implant rupture, 2 of which were asymptomatic. The symptom presentation correlated with the side of implant rupture in 7 patients (53.8%). The number of referrals to BSOPC increased to 752, in comparison to the same time period in 2011 and 2010 (698 and 630) and constituted nearly 7% of new referrals. The median time from referral to clinic was 21.5 days. Conclusion: In our study, 28.2% patients demonstrated ultrasound evidence of implant rupture. This did not always correlate with symptoms or clinical findings. PIP referrals constituted nearly 7% of new referrals to the BSOPC, increasing service workload. Further studies are required to evaluate the rupture rate of silicone breast implants and the impact of the ‘PIP scandal’ on NHS services.
Introduction: Patients with locally advanced primary rectal cancers receive long course chemo-radiotherapy (LCRT) to the primary tumour to facilitate surgery. Regional guidelines recommend that CT scans be performed both before and after CRT to determine the extent of distant metastases and consequently the appropriateness of radical curative surgery. This audit assessed the influence of a second staging CT post LCRT upon the decision to operate. Methods: All patients with a potentially curable primary rectal cancer who received LCRT between 01/01/06 e 21/12/2011 were identified from the Trust’s database. Timing of CT scans, MRIs, pathology reports, details of surgical interventions and clinical decisions were collected. Results: 138 patients were identified (Male 92, Female 46), median age 65.4y (23.9-85.0). Thirty-seven (27%) patients had distal metastases on 1st CT. Of these, 33% had further metastatic disease on the 2nd CT scan. However, 28 (76%) still had excisional rectal surgery. On the 2nd, post-LCRT CT, 25 patients (18%) had developed new metastatic disease, of whom 13 still proceeded to excisional rectal surgery. In 15 patients (11%) there was a change in the management as a result of the post-LCRT scan. In 8 patients this was due to progression of local disease on MRI, in 7 due to progression of distal disease on CT, in 3 of whom this was metastatic from a non-rectal primary. Conclusions: In patients with locally advanced rectal cancer, the postLCRT CT scan adds little information, changing management in 5% of patients. MRI scan of the rectal cancer alone is sufficient.
P56. Helping older women make informed choices about breast screening Harriet Walker1, Karen Collins2, Yvonne Cooper2, Malcolm Reed1, Lynda Wyld1 1 Academic unit of Surgical Oncology, University of Sheffield, Sheffield, UK
P58. The quality and readability of colorectal cancer information on the internet Swethan Alagaratnam, Perbinder Grewal, Santosh Somasundaram, Georgios Akritidis, Salvatore Guarino, Marc Winslet Department of Colorectal Surgery, Royal Free Hampstead NHS Foundation Trust, London, UK