Breast cancer

A Model for care: 6 year experience of recruitment into breast cancer trials - a single centre perspective (2015)

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Type of publication:
Poster presentation

Author(s):
Dr S Khanduri Consultant Clinical Oncologist and Sr H Moore Trust Lead Research Nurse

Citation:
Poster presented at the National Clinical Research Institute Cancer Conference, November 2015

Abstract:
The National Institute for Health research has been advised of the need to see sustained improvement in the performance of NHS providers in initiating and delivering clinical research. At Shrewsbury and  Telford NHS Trust a dedicated trials team have supported the breast oncology service to improve trials recruitment.

Over a 6 year period 1373 patients were identified as potentially eligible for opportunity to enter clinical trials and 39.8% accepted, 25.8% declined, 5 % were subsequently ineligible. A comprehensive  screening program with a dedicated clinical trials team to support patients with information can  enhance clinical trial recruitment and improve patient care. We support this as a model for care.

Link to more details or full-text: Available by e-mail from the author

Hormone therapy for breast cancer in men (2015)

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Type of publication:
Journal article

Author(s):
Khan M.H., *Allerton R., *Pettit L.

Citation:
Clinical Breast Cancer, 2015, vol./is. 15/4(245-250)

Abstract:
Breast cancer in men is rare, but its incidence is increasing, in keeping with the aging population. The majority of breast cancers in men are estrogen receptor positive. There is a paucity of clinical trials to inform practice, and much has been extrapolated from breast cancer in women. Hormone therapy represents the mainstay of adjuvant and palliative therapy but may have contraindications or poor tolerability. We review the evidence for choice of hormone therapy in both the adjuvant and palliative setting in breast cancer in men.

Breast reconstruction changes: coping mechanisms in breast cancer survivors (2015)

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Type of publication:
Oral presentation

Author(s):
*Blossom Lake, *Heidi Fuller, *Sarah Rastall, *Tamoor Usman

Citation:
San Antonio Breast Cancer Symposium, December 2015

Abstract:
Background: Breast cancer is the commonest malignancy in women. Survivorship care for breast cancer patients needs to be individualised. A key component is recognition that coping mechanisms can be changed by treatment. The aims of this study were to see how women who have had immediate breast reconstruction and mastectomy, compared to those who have mastectomy alone cope and if there were significant differences in coping styles.

Methods: A cohort study using a standardised questionnaire the Brief Cope Scale. Inclusion criteria: all women who had had immediate breast reconstruction and mastectomy in Shropshire from 2003 to 2014 for node negative ductal carcinoma in situ or invasive breast cancer. Each index patient was matched for year of diagnosis, adjuvant therapy and age to one woman who had mastectomy alone.

Results: Questionnaires were sent to 234 patients, with a 58% response rate. Significantly more patients from the reconstruction cohort coped by active coping (T value 1.66, P value 0.04). Significantly less patients coped by active venting in the reconstruction cohort (T value 1.71, P value 0.04).

Conclusion: Breast reconstruction changes coping styles of breast cancer patients, understanding this allows clinicians to individualise survivorship care.

Axillary overtreatment for minimal axillary disease in breast cancer, a 5 year audit of ipsilateral arm lymphoedema ; the real cost to patient and health service (2015)

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Type of publication:
Poster presentation

Author(s):
*Blossom Lake, Jayne Gittins, *Tamoor Usman

Citation:
European Journal of Surgical Oncology Nov 2015 41(11):p s267

Abstract:
NICE guidelines state that axillary node clearance (ANC) is the treatment of choice for the positive axilla, with up to 30% morbidity of lymphoedema. In contrast ASCO guidelines state that patients with 1 / 2 sentinel lymph node positive who have breast conserving surgery with breast radiotherapy should not have ANC. The recent ABS Consensus highlighted the need to minimise overtreatment of minimally involved malignant axilla. The aim of this audit was assess the cost of overtreatment in terms of lymphoedema.

Obesity delays 62 day treatment pathway for breast cancer (2014)

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Type of publication:
Conference abstract

Author(s):
*Lake B., *Pearson L., *Wilkins H., *Rastall S.

Citation:
European Journal of Surgical Oncology, May 2014, vol./is. 40/5(624), 0748-7983 (May 2014)

Abstract:
Introduction: There is increasing obesity in the UK, affecting 26% of women. The highest rate is in the West Midlands. (HSCIC 2013) This growing obese population will significantly impact health care. Breast cancer diagnosis and treatment have a 62 day cancer target. (CRS 2007) Accepted practice is triple assessment which is affected by elevated BMI; more difficult examination, repeated biopsy, technically difficult and time consuming imaging. This can delay diagnosis and treatment of breast cancer. Method: Somerset Cancer Database was used to identify all patients diagnosed with non-invasive or invasive Breast Cancer from 1st April 2012 – 31st March 2013 at Shrewsbury & Telford NHS Trust. Patients having hormone treatment or radiotherapy alone were excluded. Patient demographics were obtained from Pre-operative Anaesthetic Database. Biopsy rate was obtained from review. Imaging was reviewed by Breast Radiographer. SPSS was used to calculate independent T-test for statistical analysis. Results: 505 patients were diagnosed, of these 352 had surgery. Mean age 60 (30-87), mean BMI 28.6(16.5-55), with 35% of patients classified as obese. Number of days to treatment of BMI 35, 36 to 42 days was statistically significant P>0.0438 (T=2.0348, SE 2.949). Time taken for mammogram for super-obese patient BMI compared to normal BMI was significantly longer 7.5 minutes to 3.4 minutes P>0.0001 (T=11.6028, SE 0.353). Conclusion: Obesity significantly delays treatment pathway in Breast Cancer patients, and increases mammographic imaging time. These are important considerations with an increasingly obese population for health care provision planning of such patients.

Link to more details or full-text:

 

Primary uterine osteosarcoma presenting synchronously with bilateral breast carcinomas (2014)

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Type of publication:
Journal article

Author(s):
*Powell G, Barth L, Todd R, Ganesan R

Citation:
BMJ Case Reports, 2014, vol./is. 2014/, 1757-790X (2014)

Abstract:
Primary uterine sarcomas are infrequent neoplasms and most commonly leiomyosarcomas or endometrial stromal sarcomas. We report a rare case of primary uterine osteosarcoma discovered in a woman in her 60s following staging CT imaging for bilateral breast carcinomas. Examination of the subsequent hysterectomy specimen showed a tumour composed of malignant spindle cells and osteoclast-like giant cells associated with osteoid and neoplastic bone, in keeping with primary uterine osteosarcoma. Distinction of osteosarcoma from the more common carcinosarcoma is important due to the worse prognosis impacting on treatment decisions. In addition, synchronous presentation of this unusual tumour with bilateral breast carcinomas raises the possibility of a mutual genetic pathogenesis. 2014 BMJ Publishing Group Ltd.

Link to full-text: http://bmj-casereports.highwire.org/content/2014/bcr-2013-201502.abstract