Background:Tumour gene expression analysis is useful in predicting adjuvant chemotherapy benefit in early breast cancer patients. This study aims to examine the implications of routine Oncotype DX testing in the UK.Methods:Women with oestrogen receptor positive (ER+), pNO or pN1mi breast cancer were assessed for adjuvant chemotherapy and subsequently offered Oncotype DX testing, with changes in chemotherapy decisions recorded. A subset of patients completed questionnaires about their uncertainties regarding chemotherapy decisions pre- and post-testing. All patients were asked to complete a diary of medical interactions over the next 6 months, from which economic data were extracted to model the cost-effectiveness of testing.Results:Oncotype DX testing resulted in changes in chemotherapy decisions in 38 of 142 (26.8%) women, with 26 of 57 (45.6%) spared chemotherapy and 12 of 85 (14.1%) requiring chemotherapy when not initially recommended (9.9% reduction overall). Decision conflict analysis showed that Oncotype DX testing increased patients' confidence in treatment decision making. Economic analysis showed that routine Oncotype DX testing costs £6232 per quality-adjusted life year gained.Conclusion:Oncotype DX decreased chemotherapy use and increased confidence in treatment decision making in patients with ER+ early-stage breast cancer. Based on these findings, Oncotype DX is cost-effective in the UK setting.

Background Cervical cancer is a potentially preventable disease if appropriate screening and prophylactic strategies are employed. However, lack of knowledge and awareness can result in underutilization of the preventive strategies. Healthcare professionals with adequate knowledge play a huge role in influencing the beliefs and practices of the general public in a positive way. We assessed the knowledge, attitudes, and practices of cervical cancer and screening amongst female healthcare professionals at King Fahad Medical City (KFMC), Saudi Arabia. Methods We conducted a cross-sectional study on female healthcare professionals at KFMC. Data were collected using a predesigned, tested, and self-administered questionnaire. The questionnaire included specific sections to test the participants' knowledge, attitude, and practices related to cervical cancer and its screening. Data analysis was done using descriptive statistics. Results Data from 395 participants were included in the final analysis. The majority of the study participants were nurses (n = 261, 66.1%). The mean age of the participants was 34.7 years and 239 (60.5%) participants were married. Only 16 (4.0%) participants appeared to have good level knowledge of cervical cancer (in terms of risk factors, vulnerability, signs and symptoms, ways of prevention, and ways of screening) and 58 (14.7%) participants had fair level knowledge. A total of 343 (86.8%) participants believed that Pap smear test is a useful test for the detection of cervical cancer and 103 (26.2%) participants had undergone Pap smear testing. Conclusions Our study population showed poor knowledge of cervical cancer as a disease. The participants had a fair knowledge of Pap smear testing, but only a quarter of the cohort had undergone testing themselves. This study highlights the need for formal educational programs for the healthcare workers at KFMC specifically to improve their knowledge regarding the risk factors and early signs and symptoms of cervical cancer.

BackgroundIncidence of breast cancer in the Kingdom of Saudi Arabia (KSA) has increased in recent years. Screening helps in early detection of cancer and early diagnosis and timely treatment of breast cancer lead to a better prognosis. Women in the healthcare profession can have a positive impact on the attitudes, beliefs, and practices of general public. Therefore, it is important that the healthcare workers themselves have adequate knowledge and positive attitudes. We conducted a study to assess the knowledge, attitudes, and practices related to breast cancer screening among female healthcare professionals.MethodsA cross-sectional study was conducted on female health professional of KFMC (King Fahad Medical City). Data was collected using a pre-designed, tested, self-administered questionnaire. The questionnaire included specific sections to test the participants’ knowledge, attitude, and practices related to cervical cancer and its screening. Data analysis was done using descriptive statistics.ResultsA total of 395 health care workers participated in this study. The mean age of the participants was 34.7 years. Participants included physicians (n = 63, 16.0%), nurses (n = 261, 66.1%), and allied health workers (n = 71, 18.0%). Only 6 (1.5%) participants had a good level of knowledge of breast cancer and 104 (26.8%) participants demonstrated a fair level of knowledge. Overall, 370 (93.7%), 339 (85.8%), and 368 (93.2%) participants had heard of breast self-examination, clinical breast examination, and mammography, respectively. A total of 295 (74.7%) participants reported practicing breast self-examination, 95 (24.1%) had undergone clinical breast examination, and 74 (18.7%) had ever undergone mammography.ConclusionThe knowledge, attitudes, and practices related to breast cancer screening were found to be lower than expected. Active steps are required to develop educational programs for the health care staff, which might empower them to spread the knowledge and positively influence the attitudes of female patients in the hospital.

Breast cancer remains the most common cancer in women. A diagnosis of cancer during pregnancy is uncommon. In recent decades, obstetricians are seeing an increasing number of women who become pregnant or desire to become pregnant after breast cancer treatment because of a delay in childbearing for a variety of reasons, including cultural, educational, and professional. Consequently, breast cancer in young women often occurs before the completion of reproductive plans.A discussion among the patient, the oncologist, and the obstetrician on the relative benefits of early delivery followed by treatment versus commencement of therapy while continuing the pregnancy is of utmost importance in order to reach a consensual decision. The best available evidence suggests that pregnancy after breast cancer increases the risk of recurrence. The birth outcome in women with a history of breast cancer is no different from that in the normal female population; however, increased risks of delivery complications have been reported in the literature.As concurrent pregnancy and breast cancer are uncommon, there are no data from large randomized trials; hence, recommendations are mainly based on retrospective studies.

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Goals: International guidelines support the use of the Oncotype DX derived Recurrence Score (RS) to provide additional prognostic and predictive information in early breast cancer but experience in the UK is limited. In our prospective study we evaluate this test for the NHS and its impact on costs (subject of a separate abstract) and treatment recommendations by UK oncologists.Methods: 150 tests were made available to consecutive patients with ER+, pN0 or pN1mic early breast cancer who had no contraindication to adjuvant chemotherapy (CT) and who would accept chemotherapy if recommended. CT recommendations of oncologists based on Adjuvant! Online figures were recorded at an initial consultation and again after a second consultation once the RS was available.Results: Analysis is based on 142 patients. (150 tests performed, 3 failed to give a result, 3 repeated tests giving a result on the second block, one bilateral and one test stopped because the patient withdrew from the study). Initial treatment recommendations changed in 38 (26.8%) cases. Of the patients initially recommended CT + HT (total 57 patients), 26 (45.6%) patients were spared chemotherapy after review of the RS. Of the 85 patients initially recommended HT only (total 85 patients), 12 (14.1%) were changed to HT+CT. Further analysis shows that Grade and PR by IHC are correlated to RS. (Spearman rank correlation for grade is 0.05, 95%, Cl 0.36 to 0.61 and for PR by IHC is -0.49, 95%, Cl -0.60 to -0.35). If testing had been confined to patients initially recommended chemotherapy and patients with Grade 2/3 tumours plus a PR by IHC of 6 or less (84 patients) then 35 of the 38 (92.1%) changes in CT recommendations would have been included and the cost the test avoided in 58 (40.8%) of the patients. Conclusion:The results of our study suggest that Oncotype DX is applicable and feasible to perform in UK patients with a reduction in the use of adjuvant chemotherapy consistent with findings of other reported studies. RS added prognostic information beyond information provided by Adjuvant!

Abstract:Hand-foot syndrome (palmoplantar erythrodysesthesia or Burgdorf reaction), is a distinctive skin toxicity affecting the palms and soles after certain chemotherapeutic drugs. Docetaxel induced hand-foot syndrome is rare, dose-dependent adverse event.Here in we report a case of Docetaxel induced grade III hand-foot syndrome at low doses (75/m 2 ).

A common side effect of chemotherapy in breast cancer is early menopause in premenopausal patients, which is mainly a result of an indirect form of ovarian ablation, and is associated with substantial impairment of quality of life. Suppressing the production of ovarian estrogen has been shown to reduce the recurrence of hormone receptor-positive early breast cancer in premenopausal women, but whether it has an added advantage over tamoxifen is being discussed. Types of permanent ablation of the ovarian function include surgical oophorectomy and radiation-induced ovarian failure. Both are associated with similar response rates in hormone receptor-positive metastatic breast cancer. Medical castration with luteinizing hormone-releasing hormone analogs (LHRHa) has the benefit of being a reversible approach. Another advantage that premenopausal patients who wish to reduce the risk of developing premature ovarian insufficiency induced by chemotherapy may be offered LHRHa irrespective of whether they desire pregnancy and their age at diagnosis. This also helps reduce the risk of menopausal signs and symptoms as well as the loss of bone density in the long-term, which are primary concerns for women. This is of utmost importance to premenopausal women who do not want to conceive after treatment or are not candidates for fertility preservation strategies because of age. It should be emphasized that for women who are interested in fertility preservation, gamete cryopreservation remains the first option, and LHRHa is not an alternative. During chemotherapy, however, temporary ovarian suppression with LHRHa may be given to women who either have no access to a fertility clinic or who have declined chemotherapy or have contraindications.