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.