BREAST cancer patients at Basildon University Hospital are being offered a new follow-up service to support them in the months and years after treatment.
Every year in Britain, 50,000 women are diagnosed with breast cancer. The good news is that survival rates are improving, and have been for the last 30 years, largely due to screening, earlier diagnosis and better treatments.
For this reason the NHS’s Independent Cancer Taskforce recommended a rethink of the follow-up pathway for all cancer patients. In the light of this, breast cancer patients at Basildon University Hospital are being offered a new ‘Open Access’ service to support them after completion of their treatment.
Lesley Ashley, breast cancer nurse, explains: “Open Access is about helping our patients to live well. The current system requires patients to return for review by both a surgeon and an oncologist, at least once a year, for five years following completion of treatment for breast cancer. This adds up to more than 2,000 outpatient appointments per year, in clinics where we are also seeing newly diagnosed breast cancer.”
The breast care team emphasise that with Open Access, women will still receive the necessary checks following their treatment.
Lesley says: “We will continue, as before, to do annual scans, for the following five years after treatment has finished, or until the patient reaches the age of 50, whichever is the latest.
“And if the patient has any new symptoms or concerns they can call a designated helpline and speak to a breast cancer nurse. There will be protected slots in surgical and oncology clinics for fast track re-entry into the system should further tests be required.”
Breast cancer treatment can take many months. When completed, patients see a breast cancer nurse to discuss their diagnosis, treatment and follow-up. They are given a written discharge summary, an information leaflet and the helpline number. The same information is given to the patient’s GP.
Patients will be invited to breast cancer workshops where clinical staff will provide specialised information on topics such as medication, self-examination and managing lymphoedema, (a build-up of fluid which can follow breast surgery or radiotherapy).
Lesley adds: “Our main aim is to support patients to be independent so they can have a life that is worth surviving, after cancer. At the same time, we will be able to give time for our new patients when they really need it.”
Three women who have completed treatment for breast cancer agree. Tracey Lane, Lauren Hogan and Janet Abrams attended a recent wellbeing event and breast cancer workshop at the hospital.
Tracey, from Grays, said: “At first I wondered how the new follow-up would work but I had my mind put at rest by the nurses. They call me and see how I am even if I don’t phone them and I know I can call them any time, whatever my question. They always listen and there is no turning you away.”
Janet, from Wickford, said: “I felt worried three times and each time I phoned the clinic they called back within ten minutes. They have been marvellous; if another ultrasound is needed it gets done quickly. Sometimes you just need reassurance from them, but if you are still worried they will get you to come in.”
Lauren, from Laindon, added: “With the old system you could find a lump but might wait for your next appointment, which could be a mistake. With open access you know you will be seen quickly. We have an open door to the nurses and if necessary they will get us in as a priority.”
Better diagnosis helps more women avoid surgery
A new procedure at the breast unit will mean that over 100 breast cancer patients each year will avoid extensive surgery to remove their lymph nodes.
Radio-labelled sentinel lymph node biopsy allows doctors to determine whether there is cancer in the lymph nodes, and if there is, its precise location. This means that most patients undergo a shorter operation through a small incision.
The new biopsy procedure is up and running thanks to the efforts of Mr Ali Salih, lead consultant, breast and general surgeon, (above, second from left), Mr Wayne Chicken, consultant, breast and general surgeon (above, right) and Lesley Hearn, imaging cross- sectional lead. The new equipment was purchased with money from the hospital’s charitable fund.
Mr Salih explains: “The most common place where cancer spreads after the breast is the lymph glands in the armpit, so we have to check every patient carefully.”
At Basildon Hospital, approximately 200 women are treated for breast cancer each year. In about a fifth of cases, doctors can determine by physical examination, scan and biopsy that the patient definitely needs to have surgery to remove all, or most of, the lymph nodes at the same time as the breast surgery.
Mr Salih continues: “In the remaining 80% of patients, there will be no initial sign of lymph gland involvement, but there is still a one in five chance it has spread there.”
To discover if their lymph glands are affected, these patients will now be offered a radio- labelled sentinel lymph node biopsy.
“By precisely targeting the affected lymph nodes, we can shorten the procedure time and avoid making unnecessarily large incisions and dissection,” says Mr Chicken.
“Removing all the lymph gland in the arm pit can sometimes cause complications such as nerve damage in the arm, chronic pain and a build-up of fluid in the arm, called lymphoedema.
“The new procedure will be a great benefit that we are very happy to be able to offer our breast cancer patients.”