Our analysis using this large data set suggests a statistically significant, albeit weak positive, association between antidepressant prescribing and suicide rates.

Despite the efficacy of mammography and the widespread promotion of screening programmes, a significant number of eligible women still do not attend for regular breast screening. An integrative review methodology was considered the most appropriate means to critically analyse the available literature pertaining to factors which influence participation in breast cancer screening. From the extensive literature search, 12 selected core research papers met the inclusion criteria and were incorporated in the literature review. Four themes emerged from the literature which impact on participation in mammography screening: psychological and practical issues, ethnicity issues, influence of socioeconomic status and issues related to screening programmes. The recent Independent Review Panel on Breast Cancer Screening endorsed the importance of access to information which clearly communicates the harms and benefits of breast screening to enable women to make informed decisions about their health. The recommendations from the panel and others have been included in this review.

The Infusional Services Team at a large cancer centre in Belfast, Northern Ireland, performed a cross-sectional analysis of two catheter securement technologies to address an area of frequent, but underestimated concern – peripherally inserted central catheter migration and dislodgement. Healthcare practitioner and patient feedback, along with economic impact, were assessed. The costs associated with catheter replacement during the adhesive device group study period were calculated using an average cost per insertion, based on material costs required for the procedure. Other factors were the replacement cost of the adhesive engineered securement device with each dressing change. In the subcutaneous securement group, the material costs were adjusted for use of the subcutaneous device as it remained in situ for the duration of the catheters’ dwell time. This review found that subcutaneous securement offers both patient and facilities a safe, effective and economical alternative for device securement with patients who are unable to tolerate or have successful securement with adhesive securement devices. The use of subcutaneous devices provided for reduced risks for peripherally inserted central catheters in terms of dislodgement, migration or malposition, alleviating the potential risks to develop catheter-related thrombosis and device-related infection.

112 Background: Systemic anti-cancer therapy (SACT) administration rate at the end of life has been deemed a key metric for assessing quality of cancer care. A structured peer review process has been developed within the Cancer Centre, Belfast City Hospital, to discuss all patient deaths occurring within 30 days of SACT across Northern Ireland at a monthly, multidisciplinary, educational mortality meeting. We aimed to review cases discussed, characterising patients, causes of death and the role of SACT in patients’ deaths. Methods: A retrospective analysis was undertaken of 282 solid tumour patients, whose deaths were discussed at the mortality meetings from January 2013 to August 2016. Results: The 30-day mortality rate for the Cancer Centre was 4.5%. Most commonly represented tumour sites were gastrointestinal (39%), lung (22%) and breast (17%) with 96% receiving palliative treatments. WHO Performance Status (PS) was 0-2 at final SACT cycle in 83% (8% PS 3, unknown 9%). 43% of patients were receiving their first cycle and 56% receiving first line treatment for advanced disease. 77% of deaths occurred in hospital with 57% attributed to progressive disease. Other causes of death included infection (7% neutropenic, 11% non-neutropenic) and thromboembolism (12%). In 10% SACT was deemed to have caused or hastened death whereas in 65% SACT was non-contributory. In 25% SACT did not play a major role, but a contributory role could not be confidently excluded. Conclusions: SACT related death rate appears comparable to other institutions’ published routine outcomes. Robust review of SACT mortality encourages service improvement and individual reflection. Prescribers are reminded of the critical importance of carefully balancing patients’ needs and concerns with realistic outcomes and treatment risks, particularly in heavily pretreated or poor PS patients. Case discussions have generated service improvements including site and regimen specific prepopulated consent forms, a standardised SACT assessment proforma and mandatory response assessments as part of SACT protocols. Neutropenic sepsis remains the leading cause of SACT related mortality and further innovative improvements in care are required.