P105. How end of treatment nursing consultations continued via telephone due to COVID-19

Abstract

s European Journal of Surgical Oncology 47 (2021) e296ee347 P102. REPORTING AND MANAGEMENT OF CLOSE/INVOLVED ANTERIOR MARGINS AFTER SKIN/NIPPLE-SPARING MASTECTOMY: MULTI-CENTRE EXPERIENCE OF NATIONAL ONCOPLASTIC FELLOWS IN ENGLAND Hirah Rizki , Edel Quinn , Laura Arthur , SreeKumar Rajan , Reena Shah , Rachna Goburdhun , Qing Tan , Abbie Layton , April Covington , Jajini Varghese , Edward St John , Daniel Leff , Neill Patani . 1 The Royal Marsden Hospital, London, United Kingdom; Manchester University NHS Foundation Trust, Manchester, United Kingdom; Royal Victoria Infirmary, Newcastle, United Kingdom; Nottingham University Hospitals, Nottingham, United Kingdom; Royal Free Hospital, London, United Kingdom; 6 St Barts Hospital NHS Trust, London, United Kingdom; Charing Cross Hospital, London, United Kingdom; 8 Imperial College London, London, United Kingdom; University College London, London, United Kingdom Introduction: Skin or nipple-sparing mastectomies (SNSM) with immediate reconstruction are increasingly undertaken for breast cancer. However, there remains a lack of evidence to guide the management of close/ involved anterior margins after SNSM. This study aimed to explore national variability in anterior margin reporting, establish the incidence of close/involved anterior margins and identify management differences within high-volume oncoplastic units. Methods: Retrospective multi-centre observational study of patients with primary invasive or in-situ carcinoma undergoing SNSM and immediate reconstruction in 2019. Approximately 50 consecutive patients were included from each of six participating oncoplastic Training Interface Group (TIG) units in England. Results: 300 cancers (43% invasive, 31% non-invasive and 26% mixed) in 299 patients were analysed. Anterior margins were specifically reported in 240/300 (80%) cases (range: 26-100% across units). There was disease (invasive or non-invasive) either involving, or close to (<1mm), the anterior margin in 67/240 (28%) cases (8% involved and 20% close). Multidisciplinary discussion of close/involved anterior margins after SNSM occurred in 99% of these cases (range: 89-100% across units). Management was unaltered for the majority of patients (57/67, 85%). In cases where close/involved anterior margins did alter management (10/67, 15%), five patients had re-operative intervention (disease identified in one), four received radiotherapy (not otherwise indicated) and one was recommended mammographic surveillance of the reconstructed breast. Conclusions: There is considerable national variation in reporting and management of close/involved anterior margins after SNSM. Further work is required to evaluate the potential impact of anterior margin status on local recurrence and the efficacy. P103. INTRAOPERATIVE INKING OF BREAST SPECIMENS IMPROVES MARGIN ORIENTATION CONCORDANCE BETWEEN THE OPERATING THEATRE AND THE PATHOLOGY LABORATORY Edward St John, Lynsey Williams, Ashley Gilchrist, Anna Heeney, Samantha Muktar, Rachel O Connell, Ashutosh Nerurkar, Jennifer Rusby, Katherine Krupa, Peter Barry. The Royal Marsden NHS Foundation Trust, London, United Kingdom Introduction: Discordance in specimen orientation identified by surgeon and pathologist is high (>30%) when marking sutures alone are used (P061: Imprecision of sutures for margin orientation following breastconserving surgery. St John et al. EJSO, 2020, Vol 46, Issue 6, e26-e27). Correct orientation is important as re-excision is recommended for close or positive radial tumour margins. The aim was to introduce intraoperative inking of specimens to evaluate whether this improves margin concordance with the pathology laboratory. Methods: A clinical re-audit (RMH-BR162) was performed August 2020December 2020. Prospective data was collected from 64 patients in patients undergoing breast-conserving surgery. All specimens were orientated intraoperatively with long lateral/short superior dyed marking stitches and intraoperative ink (anterior yellow, posterior black, superior blue, inferiorgreen, medial orange, lateral red). An additional undyed loop stitch was placed into the specimen. We compared reported e323 location of the additional stitch and specimen measurements and weights between surgeons, and pathologists who were blinded to the intra-operative data. Results: Margin face discordance between surgeons and pathologist was 3% (n1⁄42/64) following intra-operative inking, a significant reduction (p<0.05) compared to >30% (n1⁄444/135) in our previous study with marking stitch orientation only. There was no significant difference between specimen measurements (height, length, width, weight) intraoperatively and in the pathology laboratory (p>0.5). Conclusion: Preliminary results indicate that intraoperative specimen inking significantly reduces margin disorientation between theatres and the pathology laboratory, hence improving identification of the correct margin. This simple and effective method should be considered for introduction into routine breast surgical practice. P104. RISK MANAGEMENT OPTIONS FOR BRCA MUTATION CARRIERS: A DECISION-MAKING NEEDS ASSESSMENT Yvonne Hanhauser , Sarah McGarrigle , Carol Spillane , Niamh Byrne , Geraldine Prizeman , Amanda Drury , Elizabeth Connolly , Anne-Marie Brady . 1 St. James s Hospital, Dublin, Ireland; 2 Trinity College Dublin, Dublin, Ireland; University College Dublin, Dublin, Ireland; 4 St. James s Hospital and Trinity College Dublin, Ireland Womenwith a pathogenic mutation in the BRCA1 or BRCA2 genes have an elevated lifetime risk of developing breast and ovarian cancer. To address this risk, women are managed with a combination of surveillance and/or risk-reduction strategies including prophylactic surgery or risk-reducing medication (chemoprevention). Decisions about risk-reducing strategies can be complex, personal and multifactorial. Furthermore, within the clinical environment there may be variations of recommendations provided between clinicians that could potentially leave women uncertain and less able to choose a risk management pathway. The overall aim of this project is the development of a web-based patient decision aid toolkit for BRCA mutation carriers that will improve the decision-making process by providing the user with information about their cancer risk, surgical /medical options for risk management and potential side effects. This will assist women in understanding their risk and empowering them to make informed choices as part of their personal risk management strategy. With appropriate ethical approval, a decision-making needs assessment was conducted to identify the information needs of women with a BRCA mutation who are making decisions between cancer risk reduction strategies and surveillance. Semi-structured interviews were held with cancer unaffected BRCA mutation carriers (n 1⁄4 16) and key stakeholders including healthcare professionals, policy makers and patient group representatives (n1⁄4 10). Data will be analysed by thematic content analysis. Data analysis is ongoing and will be presented at the conference. Results from this decision-making needs assessment will inform the topics and content for the BRCA+ Risk Reduction Patient decision aid. P105. HOW END OF TREATMENT NURSING CONSULTATIONS CONTINUED VIA TELEPHONE DUE TO COVID-19 Sue Scarrott, Sarah Mannings, Lucy Degaris. Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kindgom Introduction: Thirlestaine Breast Centre (TBC) in Gloucestershire diagnoses approximately 700 breast cancers per annum. The Recovery Package is a recognised national programme to assist people living with and beyond a cancer diagnosis, to live well. As nurses, we are directly involved with all four components Holistic Needs Assessment, Care and Support Planning, Treatment Summary (End of Treatment Consultations) and Health and Wellbeing events. These were face to face appointments until Covid-19 impacted. Methods: TBC commenced treatment summaries in April 2018, alongside a health and wellbeing event. Due to staff redeployment for Covid, few summaries were undertaken early on in the pandemic and a catch up was required. Since May 2020, again due to Covid, these end of treatment consultations have been completed as telephone appointments. Our end of Abstracts European Journal of Surgical Oncology 47 (2021) e296ee347s European Journal of Surgical Oncology 47 (2021) e296ee347 treatment consultations are recorded on Infoflex and a new template was introduced in October 2020, which provides an opportunity for patient feedback. Results: Since May 2020, 489 telephone end of treatment consultations have taken place and we have received 34 patient feedback forms since October. Feedback is very positive I felt more comfortable to discuss worries as I was at home , it didn t feel rushed , staff are all very kind and caring . Conclusions: Our nursing experience of undertaking end of treatment consultations via telephone, has clearly demonstrated that patients have appreciated their consultations taking place, whilst enabling them to stay safe at home. Due to this being positively received, we are now continuing these by phone. P106. DEVELOPING A PATIENT GUIDE TO ENCOURAGE QUESTIONS AND SUPPORT DECISION-MAKING AROUND BREAST CANCER TREATMENT FOR OLDER WOMEN EXPERIENCE OF THE NATIONAL AUDIT OF BREAST CANCER IN OLDER PATIENTS Katie Miller , Melissa Gannon , Lis Grimsey , Jibby Medina , Karen Clements , Kieran Horgan , David Dodwell , David Cromwell . Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom; 2 East Sussex Healthcare NHS Trust, United Kingdom; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom; National Cancer Registration and Analysis Service, Public Health England, London, United Kingdom; 5 St James s University Hospital, Leeds, United Kingdom; Nuffield Department of Population Health, University of Oxford, Oxford, Unite