60 research outputs found
Selective primary systemic treatment for operable breast cancer: a randomised trial
No full textSurgical excision has been the method of choice for initial treatment of operable breast
cancer, but is limited in its potential to produce cure. Postoperative systemic therapy
prolongs survival, but kinetics theory and experimental data suggest it may be more
effective if given preoperatively, with the added advantage of leaving the tumour as a
marker of treatment progress. Important questions regarding the efficacy of primary
systemic treatment (PST), its effects on known prognostic indicators, and its influence on
surgical and psychological morbidity remain to be answered. These were addressed in this
thesis.171 women aged 27 -69 with operable (T2_31\10.1 M0) breast cancers 31 -85 mm in diameter
were randomised over 68 months, 86 to conventional treatment (CONV) and 85 to PST. In
CONY, surgery was followed by tamoxifen, except for node -positive premenopausal women
who received 6 cycles of cyclophosphamide, methotrexate and 5- fluorouracil. PST was
started after tumour oestrogen receptor (ER) measurement. Patients with ERA 9 fmol /mg
were treated by goserelin if premenopausal or with tamoxifen if postmenopausal. Response
was assessed by weekly examination. Sequential mammography and ultrasound, and
serum CA 15 -3 and HMFG2 measurements were studied as alternative means of
monitoring response. Non responding patients and all patients with ER<20 fmol /mg were
treated with 6 cycles of cyclophosphamide, doxorubicin and prednisolone (CAP). Surgery
followed 12 -16 weeks of PST. The first part of the trial included 79 patients with tumours
>40 mm, all of whom underwent mastectomy. The second part allowed tumours >30 mm,
and breast conservation was an option.The first 79 patients were studied for morbidity. All toxicity was recorded. Psychological
morbidity was assessed by means of the Hospital Anxiety and Depression, and the Mental
Adjustment to Cancer questionnaires, completed before, during and after treatment.
Surgical morbidity was recorded prospectively according to a pre- defined protocol.170 evaluable patients have been followed up for a median of 37 months and have
sustained 53 events. No survival difference has emerged. Axillary lymph nodes, ER and
tumour response have emerged as independent indicators of prognosis. Systemic therapy
produced significant changes in tumour characteristics but post treatment prognostic data
was qualitatively similar to conventionally gathered information.Patients experienced increased anxiety during PST, but psychological adjustment was
similar after completion of all treatment. Despite longer treatment for PST, quality adjusted
survival was identical to that found for CONY. Surgical morbidity was similar for both
groups.Ultrasound proved a highly effective method for measuring tumour size and response to
primary systemic therapy. Tumour marker levels were generally low and did not reflect
response.The present package of primary systemic treatment is a safe and effective method for
treating operable breast cancer, does not lead to excess morbidity, and offers the
advantages of a response based approach to therapy
Outcomes of intraoperative versus pre-operative ultrasound localisation of impalpable breast lesions in the Cambridge breast unit
No full textUtilizing the Total Design Method in medicine: maximizing response rates in long, non-incentivized, personal questionnaire postal surveys
No full textFawz Kazzazi,1 Rebecca Haggie,1 Parto Forouhi,2 Nazar Kazzazi,3 Charles M Malata2,4,5 1Clinical School, University of Cambridge, Cambridge, UK; 2Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s University Hospital, Cambridge, UK; 3Jasmine Breast Centre, Doncaster Royal Infirmary, Doncaster, UK; 4Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s University Hospital, Cambridge, UK; 5Postgraduate Medical Institute, Faculty of Medical Sciences, Anglia Ruskin University School of Medicine, Cambridge, UK Introduction: Maximizing response rates in questionnaires can improve their validity and quality by reducing non-response bias. A comprehensive analysis is essential for producing reasonable conclusions in patient-reported outcome research particularly for topics of a sensitive nature. This often makes long (≥7 pages) questionnaires necessary but these have been shown to reduce response rates in mail surveys. Our work adapted the “Total Design Method,” initially produced for commercial markets, to raise response rates in a long (total: 11 pages, 116 questions), non-incentivized, very personal postal survey sent to almost 350 women.Patients and methods: A total of 346 women who had undergone mastectomy and immediate breast reconstruction from 2008–2014 (inclusive) at Addenbrooke’s University Hospital were sent our study pack (Breast-Q satisfaction questionnaire and support documents) using our modified “Total Design Method.” Participants were sent packs and reminders according to our designed schedule. Results: Of the 346 participants, we received 258 responses, an overall response rate of 74.5% with a useable response rate of 72.3%. One hundred and six responses were received before the week 1 reminder (30.6%), 120 before week 3 (34.6%), 225 before the week 7 reminder (64.6%) and the remainder within 3 weeks of the final pack being sent. The median age of patients that the survey was sent to, and the median age of the respondents, was 54 years.Conclusion: In this study, we have demonstrated the successful implementation of a novel approach to postal surveys. Despite the length of the questionnaire (nine pages, 116 questions) and limitations of expenses to mail a survey to ~350 women, we were able to attain a response rate of 74.6%. Keywords: breast, surgery, postal survey, oncology, cancer, breast reconstruction, immediate postmastectomy breast reconstruction, patient satisfaction, PROM
An evaluation of incidental metastases to internal mammary lymph nodes detected during microvascular abdominal free flap breast reconstruction
No full textThe past, the present and the future of UK breast reconstruction—are our practices outdated in 2020?
No full textDescription to be added.Cannot be left empt
Successful Deep Inferior Epigastric Perforator Flap Harvest despite Preoperative Therapeutic Subcutaneous Heparin Administration into the Abdominal Pannus
No full textAbdominal free flaps for microsurgical breast reconstruction are most commonly harvested based on the deep inferior epigastric vessels that supply skin and fat via perforators through the rectus muscle and sheath. Intact perforator anatomy and connections are vital for subsequent optimal flap perfusion and avoidance of necrosis, be it partial or total. The intraflap vessels are delicate and easily damaged and it is generally advised that patients should avoid heparin injection into the abdominal pannus preoperatively as this may compromise the vascular perforators through direct needle laceration, pressure from bruising, haematoma formation, or perforator thrombosis secondary to external compression. We report three cases of successful deep inferior epigastric perforator (DIEP) flap harvest despite patients injecting therapeutic doses of low molecular weight heparin into their abdomens for thrombosed central venous lines (portacaths™) used for administering primary chemotherapy in breast cancer
Utilizing the Total Design Method in medicine: maximizing response rates in long, non-incentivized, personal questionnaire postal surveys
No full textIntroduction: Maximizing response rates in questionnaires can improve their validity and quality by reducing non-response bias. A comprehensive analysis is essential for producing reasonable conclusions in patient-reported outcome research particularly for topics of a sensitive nature. This often makes long (≥7 pages) questionnaires necessary but these have been shown to reduce response rates in mail surveys. Our work adapted the “Total Design Method,” initially produced for commercial markets, to raise response rates in a long (total: 11 pages, 116 questions), non-incentivized, very personal postal survey sent to almost 350 women.
Patients and methods: A total of 346 women who had undergone mastectomy and immediate breast reconstruction from 2008–2014 (inclusive) at Addenbrooke’s University Hospital were sent our study pack (Breast-Q satisfaction questionnaire and support documents) using our modified “Total Design Method.” Participants were sent packs and reminders according to our designed schedule.
Results: Of the 346 participants, we received 258 responses, an overall response rate of 74.5% with a useable response rate of 72.3%. One hundred and six responses were received before the week 1 reminder (30.6%), 120 before week 3 (34.6%), 225 before the week 7 reminder (64.6%) and the remainder within 3 weeks of the final pack being sent. The median age of patients that the survey was sent to, and the median age of the respondents, was 54 years.
Conclusion: In this study, we have demonstrated the successful implementation of a novel approach to postal surveys. Despite the length of the questionnaire (nine pages, 116 questions) and limitations of expenses to mail a survey to ~350 women, we were able to attain a response rate of 74.6%
The Comparison of Strattice and SurgiMend in Acellular Dermal Matrix-Assisted, Implant-Based Immediate Breast Reconstruction
No full text
Patient-reported satisfaction following mastectomy and immediate reconstruction does not change with time
No full text- …
