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.