1. Early and locally advanced breast cancer
Nb numbers in brackets denote relevant paragraphs in the breast cancer service guidance
Recovery Package:
Whole needs assessment.
A treatment summary (including surveillance programme) sent to the patient and their GP.
Information on likely side-effects of treatment and how best to manage these.
Information on potential symptoms of recurrence/secondary cancers and what to do in these occurrences.
Key contact point for rapid re-entry if symptoms of recurrence are experienced or if serious side effects become apparent.
Access to a patient education and support event, such as a Health and Wellbeing Clinic, to prepare the person of the transition to supported self-management, including advice on healthy lifestyle and physical activity. Referral to a health trainer is often helpful.
Signposting to rehabilitation, work and financial support services.
Advanced disease (please see metastatic breast cancer pathway)
No cancer- reassure discharge
Staging tests (imaging)
(3.2.2)
1st OPA:
Triple Assessment
Examination
Mammogram/ ultrasound of breast and axilla
Biopsy
(3.2.1)
2nd OPA:
Surgical, ER and HER2 receptor results
(3.2.3)
Surgery:
Wide local excision or mastectomy +/- reconstruction and axillary staging or treatment
( )
GP Referral
Stratified Open Access Follow up
(3.2.54, appendix 5)
Neo adjuvant systemic therapy:
Chemotherapy +/-
Biological therapy or endocrine therapy
(3.2.16, )
Holistic Needs Assessment and access to a CNS
(3.2.8, 3.2.9)
Adjuvant therapy:
Endocrine +/-
Chemotherapy +/-
Anti-HER2 therapy +/-
Radiotherapy +/-
Biological therapy +/- consider clinical trial
( , appendix 4)
Consider clinical trial
(3.2.7, )
Recovery Package at end of acute treatment
(3.2.45, and above)
Screening
Breast MDT (weekly)
(3.2.5, 3.2.6)
MDT (post-operative results)
Cure – 75%
Family History
Advanced/metastatic disease – 25% (please see metastatic breast cancer pathway)
Mammographic surveillance
(3.2.55)
Consider clinical trial
(3.2.7, )
A&E
Areas covered by breast cancer service guidance
Abbreviations:
A&E – Accident and Emergency
CNS – Clinical Nurse Specialist
ER – Oestrogen Receptor
GP – General Practitioner
HER2 – Human Epithelial Growth Factor receptor
OPA = Outpatient Appointment
MDT – Multidisciplinary team
Key:
= Primary care
= Secondary care
Breast Cancer Clinical Reference Group, October 2015

2. Metastatic breast cancer
Nb numbers in brackets denote relevant paragraphs in the breast cancer service guidance
1st OPA:
Triple assessment (if not previously done)
(3.2.1, )
Holistic needs assessment by specialist metastatic cancer nurse
(3.2.47, )
Palliative
Endocrine therapy +/-
Chemotherapy +/-
Anti-HER2 therapy +/-
Radiotherapy +/-
Biological therapy +/-
Surgery +/-
Bisphosphonates
(3.2.49, )
Health needs assessment by specialist metastatic cancer nurse
(3.2.47, )
Consider clinical trial
(3.2.52)
OPA attendance and monitoring scans
2nd and subsequent lines of systemic therapy
(3.2.49, )
Recurrence
Breast MDT
(3.2.46)
2nd OPA:
Treatment plan
Disease progression
End of life care
Staging:
Imaging and biopsy of primary or metastases
(3.2.2)
First presentation
Palliative care as and when appropriate
Areas covered by breast cancer service guidance
Key:
= Secondary care
Abbreviations:
OPA = Outpatient Appointment
MDT – Multidisciplinary team
Breast Cancer Clinical Reference Group, October 2015