Around 6,500 women over 70 die from breast cancer each year in the UK, and many older patients receive less aggressive treatment than younger women—even when they could benefit. This research asks whether older women are being undertreated, and whether a pre-treatment health assessment could reduce complications like chronic lymphoedema, a painful arm swelling that affects 40% of patients after lymph node removal. The team will compare surgeons’ and patients’ views on who makes treatment decisions, test whether a health assessment protocol improves outcomes for elderly patients, and evaluate whether early intervention for arm swelling at six months can prevent chronic lymphoedema. They will also compare two measurement techniques—perometer and bioimpedance—to see which better predicts the condition. If successful, this work could change clinical practice by ensuring older women receive treatment matched to their health status rather than their age, and by introducing routine early monitoring to prevent a common, distressing complication. The findings would directly improve quality of life for thousands of breast cancer survivors and reduce long-term NHS costs.
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AIMS AND OBJECTIVESTo enhance quality and duration of breast cancer survivorship in a cost efficient manner.MAXIMISING SURVIVAL1a) determine whether older women are being under treated for breast cancer once patient choice, tumour characteristics, health status and other confounder variables have been taken into account.. Choice will be measured by establishing and comparing surgeons’ perceptions of responsibility for the surgical decision with those of the patients.MINIMISING COMPLICATIONS1b) undertake feasibility studies of whether pre-treatment health assessment protocol increases optimal management and reduces complications amongst elderly breast cancer patients;2) compare arm swelling perometer measurements with multi-frequency bioimpedance in the prediction of chronic lymphoedema after axillary node clearance (ANC);3) determine if early intervention in women developing arm swelling by 6 months post surgery prevents development of chronic lymphoedema.BACKGROUNDBreast cancer is diagnosed in 44,000 and kills 12,000 women per year in UK. A disproportionate number of deaths (6,500) occur in women aged >70 years. Aggressive treatment improves survival, but increases the frequency of late complications.Older women are less likely to receive triple assessment and under-treatment of their breast cancer is common. Survival for older women is poorer in UK than in a number of comparable countries.Around 30% of patients are node positive and require ANC. Chronic lymphoedema is a distressing consequence of ANC in 40% of patients.Our focus is on optimising management for all women (regardless of age) while minimising the incidence and impact of common complications.RESEARCH PLANSResearch is organised into 3 workstreams (WS). WS1 concentrates on optimising therapy. WS2 and WS3 concentrate on minimising or preventing complications after treatment.RESEARCH TEAMThe team brings together senior NHS clinicians and researchers with a track record of innovation and delivery of health service research for patient benefit with experts in biostatistics, health economics, health related quality of life (HRQoL), NHS service management and includes patient representatives.We have published Department of Health (DH) funded randomised controlled trials (RCTs) which altered practice nationally. The team has over 1,000 peer reviewed publications with more than £30m of peer reviewed grants currently active.Bundred/Purushotham/Fallowfield are past or present members of the National Cancer Research Institute (NCRI) Breast Clinical Studies Group and are Chief Investigators in NCRI studies with peer reviewed research grants focussed on patient benefit. Todd is a current member of Primary Palliative Care NCRI subgroup.RESEARCH ENVIRONMENTThe programme is based in a £12m breast centre at the University Hospital of South Manchester (UHSM) which treats over 700 new cancers annually and collaborates with several breast units to allow demonstration of general applicability of findings. Bundred is Clinical Lead for Research for the Greater Manchester and Cheshire Cancer Research Network (GMCCRN) and dissemination to the network will be through links with the National Cancer Research Network (NCRN) and NHS Breast Screening Programme. Manchester Cancer Studies and Nursing were both the top rated groups in the Research Assessment Exercise (RAE) 2008.Partners include the University of Manchester, Christie Hospital NHS Trust and Universities of Sussex, Liverpool and London will all contribute to the programme. Trusts in Oldham, Bournemouth, Poole, Derby, London and North Staffordshire will contribute patients to the programme.ANTICIPATED OUTPUTSWS1 – optimise treatment for elderly patients with breast cancer;WS2 – demonstrate whether diagnosis of lymphoedema with multi-frequency bioimpedance is more sensitive and specific than arm volume measurement in predicting chronic lymphoedema development after ANC;WS3 – prevent lymphoedema development after ANC by prophylactic ext
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