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Dawn Symonds

Dawn Symonds. Clinical Nurse Specialist Sunrise Cancer Unit Wycombe Hospital Buckinghamshire Hospitals NHS Trust. Five Year follow up policy for patients treated for breast cancer. Previously. All breast patients seen in same clinic This means; New patients with any breast problems

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Dawn Symonds

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  1. Dawn Symonds Clinical Nurse Specialist Sunrise Cancer Unit Wycombe Hospital Buckinghamshire Hospitals NHS Trust

  2. Five Year follow up policy for patients treated for breast cancer

  3. Previously • All breast patients seen in same clinic • This means; • New patients with any breast problems • Patients returning for results of core biopsy • Patients returning for results of surgery • Patients any where in their follow-up schedule

  4. Which meant • Junior staff (SHO’s) where generally doing the follow up work. • Junior staff not confident to discharge patients. • Leading to overload in clinics.

  5. Which resulted in: • A haphazard service • Surveillance mammograms not done as required • Patients not discharged • Advise not given on how to reaccess the service. • Advise not given on continuing mammograms

  6. Catalyst for change • Woman seen in clinic fourteen years post mastectomy.

  7. Prepare to change • Discussion at MDT • Looked at what was needed • Agreed what was achievable • Protocol written • Discussion at MDT • Protocol agreed

  8. Surgical Follow-up Protocol for Operable Breast Cancer • Clinic appointments: conservative surgery or mastectomy • 1 week post-op to discuss results  • 6 month following oncological treatment • 1 year • 2 years • 3 years • 5 years – then discharge if recurrence and symptom free

  9. Mammography: conservative surgery i.e. WLE or Quadrantectomy 1 year ) 2 years ) Bilateral 3 years ) 5 years )

  10. Mammography: mastectomy 1 year ) 3 years ) Contralateral Breast 5 years )

  11. Continuing Surveillance Both groups to have 2 yearly mammography on a call / recall basis (via breast screening if in catchment age range) after discharge and to have an open access appointment.

  12. Problems • Mr Mc Pherson • Mr Elzayat

  13. Educating patients • Discussed patient representatives • Flow chart drawn up and given to patients explaining what to expect. • Explanation given to patient on rational for discontinuing follow up and re accessing system.

  14. Advantages • Clinics not so busy • More time for patients who need it. • Less stressed doctors generally but especially SHO’s • Better chance of seeing patients with a problem when they need to be seen.

  15. The Future • NICE Guidelines to be adopted so protocol will change.

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