Optimising care beyond breast cancer – perspectives from the front line


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Alastair M Thompson1, Maggie Wilcox2,
1University of Texas MD Anderson Cancer Center, Houston, USA,2Independent Cancer Patients' Voice, London, UK

Abstract

The success of the treatments for breast cancer has resulted in 10 year survival for some 80% of women in the UK, with millions of women worldwide living with the consequences of treatment.

Three areas which particularly impact the experience of breast cancer survivors - and primary care - include the surgical pathway and follow up regimens, the consequences of endocrine therapy and impacts on upper limb function.

There are contrasts and cultural differences across the globe between the processes a patient may go through having surgery and in follow up. Short stay surgery requires planning and excellent post-operative care in the community; trials for women with breast cancer have demonstrated the benefits of early discharge to primary care with a drain in place. Determining the frequency and modalities of follow up radiologically (such as in the Mammo50 trial) and clinically (primary care follow up, nurse/allied health professional-led follow up in primary or secondary care) present opportunities to improve patient experiences.

Managing the consequences of (extended) adjuvant endocrine therapy balanced with adherence to therapy is a key issue for women surviving oestrogen receptor positive breast cancer. These individuals remain at long term risk of recurrent or new breast cancers mitigated by the use of tamoxifen or aromatase inhibitors (AIs) for 5 years and more. Yet effective management of symptoms or interventions for adherence remain elusive.

Reducing upper limb complications through less axillary surgery (including sentinel node biopsy, the Z0011, SNAC1 trial results and the POSNOC trial now underway) and rehabilitating the upper limb (the future PROSPER trial) present clear opportunities.

Differences between health care systems present further challenges and opportunities to optimise life after breast cancer. For those in the front line, living beyond breast cancer acknowledges the inheritance from treatments and requires a multidisciplinary interface between primary and secondary care.

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