2018

An audit of 'real world' systemic chemotherapy in breast cancer patients over the age of 70 in one U.K. Cancer Centre (2018)

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Type of publication:
Conference abstract

Author(s):
*Choudhary Y.; *Pettit L.; *Khanduri S.

Citation:
European Journal of Surgical Oncology; Mar 2018; vol. 44

Abstract:
Background: Breast cancer incidence among the over 70's is increasing. Trial data from this age group is not as extensive when compared with younger patients. Co-morbidities are common and may lead to poor tolerance of chemotherapy. Cytotoxic chemotherapy usage in patients over 70 was audited to record toxicity and tolerability.Method: Patients aged >70 years, diagnosed with invasive breast cancer between 01/01/2015 and 31/12/2015 treated with cytotoxic chemotherapy at the Shrewsbury and Telford Hospital NHS Trust were identified from the Somerset database. Clinical information was obtained from an electronic portal. Data collected: demographics, performance status, tumour characteristics, ER/PR and HER2 status, chemotherapy regimen, treatment intent, number of chemotherapy cycles planned, number given, toxicities, and hospital admissions. Data was collected on an excel database.Results: Thirty patients were identified, all female. 26 were between 71 and 75, 2 were between 76 and 80, 2 > 80 years. 20 patients (67%) ER/PR receptor positive. 15 (50%) HER2 positive. The majority 29 (97%) had a performance status of 0/1. Cardiovascular co-morbidities were the most common (57% pre-existing cardiovascular disease). 25 (83%) were treated with adjuvant intent. 15 (50%) were admitted to hospital, 6 (20%) with neutropenic sepsis. 12 (40%) had dose reductions. 21 (70%) completed their planned number of cycles. Chemotherapy was discontinued in 7 (23%) due to toxicity and 1 patient remains on treatment at the time of this audit. There were no patient deaths within 30 days of commencing chemotherapy.Conclusion: Chemotherapy usage in the >70's was associated with higher risk breast cancer. Despite good baseline performance status, 50% of patients required hospital admission and 27% discontinued treatment due to toxicity. The decision to use chemotherapy must also account for potential toxicities and impact on quality of life. Increased contact with health professionals including tele-consults and increased specialist nurse support, will help to predict and manage toxicity and reduce admissions.

Physiotherapists utilizing diagnostic ultrasound in shoulder clinics. How useful do patients find immediate feedback from the scan as part of the management of their problem? (2018)

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Type of publication:
Journal article

Author(s):
*Lumsden, Gordon; *Lucas-Garner, Kerry; *Sutherland, Sarah; *Dodenhoff, Ron

Citation:
Musculoskeletal care; Mar 2018; vol. 16 (no. 1); p. 209-213

Abstract:
AIMSPhysiotherapists are beginning to utilize diagnostic ultrasound imaging in upper limb/shoulder clinics. The aim of the present study was to receive feedback on the views of the patients concerning the usefulness of the information obtained immediately from the scan in the management of their problem.METHODS A questionnaire was offered to all patients attending a physiotherapist-led upper limb/shoulder clinic who underwent ultrasound imaging as part of a shoulder assessment over a 6-month period. A total of 103 patients completed a questionnaire for analysis.RESULTSPatients rated the ultrasound scan to be of benefit in all aspects. Regarding the ability to understand their shoulder problem better and in feeling reassured about their problem, 97% of patients either strongly agreed or agreed that this was the case. Concerning the capability of managing their problem, 89% of patients strongly agreed or agreed that they felt more able to do this. In total, 96% of patients evaluated the ultrasound scan to be of very high/high value to them.CONCLUSION Patients highly rate the information gained from ultrasound imaging in a physiotherapy-led upper limb/shoulder clinic and felt that it assisted them in the understanding, reassurance and management of their problem.

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Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair. (2018)

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Type of publication:
Journal article

Author(s):
Braunstein M, Baumbach SF, Boecker W, *Carmont MR, Polzer H.

Citation:
Knee Surgery, Sports Traumatology, Arthroscopy. 2018 Mar;26(3):846-853

Abstract:
Surgical repair after acute Achilles tendon rupture leads to lower re-rupture rates than non-surgical treatment. After open repair, early functional rehabilitation improves outcome, but there are risks of infection and poor wound healing. Minimal invasive surgery reduces these risks; however, there are concerns about its stability. Consequently, physicians may have reservations about adopting functional rehabilitation. There is still no consensus about the post-operative treatment after minimal invasive repair. The aim of this study was to define the most effective and safe post-operative rehabilitation protocol following minimal invasive repair.
METHODS: A systematic literature search in Embase, MEDLINE and Cochrane Library for prospective trials reporting on early functional rehabilitation after minimal invasive repair was performed. Seven studies were included.
RESULTS: One randomized controlled trail, one prospective comparative and five prospective non-comparative studies were identified. Four studies performed full weight bearing, all demonstrating good functional results, an early return to work/sports and high satisfaction. One study allowed early mobilization leading to excellent subjective and objective results. The only randomized controlled trial performed the most accelerated protocol demonstrating a superior functional outcome and fewer complications after immediate full weight bearing combined with free ankle mobilization. The non-comparative study reported high satisfaction, good functional results and an early return to work/sports following combined treatment.
CONCLUSION: Immediate weight bearing in a functional brace, together with early mobilization, is safe and has superior outcome following minimally invasive repair of Achilles tendon rupture. Our recommended treatment protocol provides quality assurance for the patient and reliability for the attending physician.
LEVEL OF EVIDENCE: II.