Joint morphology has a significant influence on joint motion and may contribute to the development of rotator cuff pathology, but the relationships between glenohumeral joint (GHJ) morphology and in-vivo GHJ motion are not well understood. The objectives of this study were to assess measures of joint morphology and their relationship with in-vivo joint motion in two populations: shoulders with intact rotator cuffs (n=48) and shoulders with rotator cuff pathology (n=36, including 5 symptomatic tears, 9 asymptomatic tears and 22 repaired tears). GHJ morphology was measured from CT-based three-dimensional models of the humerus and scapula. In-vivo GHJ motion was measured during shoulder abduction using biplane x-ray imaging. Associations between GHJ morphology and motion were assessed with univariate and best subsets regression. The only morphological difference identified between the populations was the critical shoulder angle (intact: 34.5±4.7°, pathologic: 36.9±5.0°, p=0.03), which is consistent with previous research. In intact shoulders, the superior/inferior (S/I) position of the humerus on the glenoid during shoulder abduction was significantly associated with the glenoid's S/I radius of curvature (p<0.01), conformity index (p<0.01), and stability angle (p<0.01). Furthermore, the S/I position of the humerus on the glenoid was negatively associated with the critical shoulder angle (p=0.04), which contradicts previous research. No significant associations between GHJ morphology and GHJ motion were detected in shoulders with rotator cuff tears. It is unknown if rotator cuff pathology compromises the relationships between GHJ morphology and motion, or if the absence of this relationship is a pre-existing condition that increases the likelihood of pathology.

Mortality is decreasing for most cancers and the overall 5-year survival rate has now reached 50% ( Fig. 1 ). The 5-year survival rate in women (56%) is higher than that in men (43%) and this gender gap is also seen for 10-year survival rates (52% for women versus 39% for men). Figure 2 shows 5-year survival rates for common cancers in the UK. The highest 5-year survival rate for men is for testicular cancer (96%) and for women is for malignant melanoma (87%).

Measures of scapulothoracic motion are dependent on accurate imaging of the scapula and thorax. Advanced radiographic techniques can provide accurate measures of scapular motion, but the limited 3D imaging volume of these techniques often precludes measurement of thorax motion. To overcome this, a thorax coordinate system was defined based on the position of rib pairs and then compared to a conventional sternum/spine-based thorax coordinate system. Alignment of the rib-based coordinate system was dependent on the rib pairs used, with the rib3:rib4 pairing aligned to within 4.4 6 2.1 deg of the conventional thorax coordinate system.

Although most oncology care takes place in secondary care, many patients are treated as outpatients. Oncology emergencies may occur when the patient is at home and the GP is often called. Therefore, it is important to know how to handle the common emergencies likely to arise. Remember that you are part of a team. For example, in many areas, there is a district or community nursing team available 24 hours a day who can be called upon to provide emergency nursing care, such as replacement dressings, or to attend to syringe drivers that have stopped functioning.

6097 Background: Clinical trials have clearly established that patients receiving taxane-based chemotherapy for metastatic breast cancer (MBC) should be treated with trastuzumab if their tumour is shown to overexpress the human epidermal growth factor receptor 2 (HER2) receptor. This is based on median survival gains for patients with HER2 positive tumours treated with trastuzumab plus taxane chemotherapy compared to taxane alone. Methods: Patients commencing chemotherapy for MBC in Northern Ireland in 2004 were identified from pharmacy records. Their case notes were retrospectively reviewed to determine whether patients in routine clinical practice had HER2 testing and trastuzumab treatment if indicated. Results: One hundred and fifty six patients commenced chemotherapy, of whom 145(93%) had HER2 testing. In 69(44%) patients the HER2 result was already available at the time of this relapse. In the remaining 76(49%) patients the result became available in a median of 41.5 (range 0–368) days. Of those tested, 48 patients (33%) were HER2 positive (immuno-histochemistry 3+ or fluorescence in situ hybridization positive). Thirty eight of these patients were treated with trastuzumab, either as a single agent or in combination with chemotherapy. There were valid reasons for trastuzumab omission in 7 of 10 patients not given trastuzumab (4 given first line anthracycline-based regimen, 1 had cardiac dysfunction, 1 had extensive lung metastastes and 1 was unfit for treatment). The data were examined for variations in chemotherapy and trastuzumab use across the 4 health boards which comprise the region. The number of patients commencing chemotherapy ranged from 6.9 to 11.4 patients per 100,000 population indicating a significantly different utilisation (p<0.001). Conclusions: In our region 145 of 156 patients who received chemotherapy for MBC were tested for overexpression of the HER2 receptor (93%). Of those patients who were eligible to receive trastuzumab 31 out of 34 (91%) received trastuzumab. There were inequalities in the region regarding chemotherapy for MBC and the time required to obtain a HER2 result averaged 41.5 days. Testing of HER2 status at time of original diagnosis would streamline management of metastatic disease. No significant financial relationships to disclose.