Edinburgh Breast Unit Treatment: Questions and Answers about Breast Cancer in South East Scotland* These questions and answers will provide an overview of the standard approaches for treating breast cancer across South East Scotland (i.e., Fife, Lothian, Borders, and Dumfries & Galloway). However, please note that each person is considered as an individual and depending on the details of their case and their own wishes for treatment, the approach taken may be different than described here. Questions about Treatment: Will my treatment be discussed by all the staff involved in my care? Does this team include cancer nurses as well as doctors? When will my treatment start? What will the treatment be like and how long will it take? Will there be side effects and what can I do about them? Is my doctor a specialist in my type of cancer? Who will give me my chemotherapy and will they have the right training? Who will give me my radiotherapy and will they have the right training? If I have to go to more than one clinic or hospital, will they know about my diagnosis and treatment? Who will arrange for any drugs or equipment I may need when I leave hospital? What do I do if I need help overnight or at the weekend? Will my treatment be discussed by all the staff involved in my care? Does this team include cancer nurses as well as doctors? The recommended treatment approaches for all new patients are discussed at multidisciplinary meetings that take place at various hospitals throughout South East Scotland. At these meetings, each person's individual case is discussed and the results of any tests are reviewed by the appropriate specialist. For example, a radiologist (consultant x ray doctor) will review the findings of each person's breast x rays (mammograms). 1
All the disciplines that look after breast cancer are present at these meetings, including specialist breast cancer nurses as well as specialist doctors. By thoroughly discussing each individual case, the team is able to agree on the best treatment plan, which will then be recommended to the patient. However, it is sometimes decided that further information, such as another test or procedure, will be necessary before the team can advise on the best management plan. When will my treatment start? Once your test results are complete and a diagnosis has been made, your case will be discussed at a multidisciplinary meeting within about a week's time to decide on the best treatment plan. Most people with breast cancer will have surgery in the first instance and this can usually be scheduled to occur within about one to three weeks from the time when a treatment plan is agreed. What will the treatment be like and how long will it take? Your experience of treatment will depend on the type of treatment you receive. Surgery, radiotherapy, and chemotherapy are the main treatments used for breast cancer and in some cases, these treatments may be used together. Surgery Surgery for breast cancer involves removing the tumour along with a small margin of healthy tissue. During the same operation, some or all the lymph nodes in the armpit are removed to check if cancer cells have spread to them, as this information is important in order to plan your treatment. In many women, the breast need not be removed (breast conservation). Surgery to completely remove the breast (mastectomy) is only done where absolutely necessary (e.g. when the removal of the cancer will cause a poor cosmetic result or when several areas of the breast are affected). Some women may choose to have a mastectomy. In those women who require a mastectomy, reconstruction of the breast wound (i.e., additional surgery to restore the natural shape of the breast) will be discussed. How long it will take you to recover from surgery depends on the amount of tissue that has been removed. If you are having a breast lump removed (lumpectomy), you can often return home the same day. The recovery from more major breast surgery will take longer; for example, if you are having a mastectomy, you may spend up to seven days in hospital. Surgery usually will be performed in a local treatment centre unless otherwise discussed. 2
Radiotherapy Radiotherapy is treatment with high energy beams of x rays, which are carefully positioned over the breast area. It is completely painless and a special x ray machine is used to deliver the treatment. If you are to receive radiotherapy, you will come to the Edinburgh Cancer Centre for treatment appointments every weekday, for a period of three to five weeks. (Some patients in Fife may receive treatment in Dundee if this is more convenient for them.) The first appointment will last approximately 30 40 minutes, however subsequent visits usually take about 10 minutes. If you are having radiotherapy following surgery, the radiotherapy appointments will usually start about six weeks after surgery, but this timeline can vary depending on the details of your case and how quickly you recover from surgery. Drug Treatments Hormone treatments and chemotherapy are the main drug treatments used for breast cancer and they are usually given after surgery. For some cases, however, it is more appropriate to receive hormone treatment or chemotherapy treatment as the first treatment (i.e., before surgery). This is sometimes done if the cancer is large, so that the drug treatments can reduce the size of the cancer before surgery, thereby reducing the overall amount of tissue that must be removed during surgery. Hormone Treatments: The majority of breast cancers are dependant on the female hormone oestrogen. Hormone treatment involves giving a drug that blocks any cancer cells from receiving oestrogen, or lowering the body's production of oestrogen. The majority of hormone treatments are given in the form of a daily tablet that is prescribed by your GP. Occasionally, a monthly injection is required and this can be given in your local health centre. Chemotherapy: Chemotherapy is the use of drugs to treat cancer. The exact schedule of treatment will depend on the type of chemotherapy drugs that are used, but a typical schedule would involve a series of six to eight treatments, each given about three weeks apart. Your health will be monitored during this period to determine how well you are tolerating the treatment and adjustments to the treatment schedule may be made based on this. Chemotherapy usually starts about four weeks after surgery, but the timing and orders of treatments (possibly including radiotherapy) may vary depending on your overall treatment plan and other details of your case. Chemotherapy can usually be given in a local treatment centre, although you may be asked to travel to Edinburgh Cancer Centre if you are having specialised chemotherapy or participating in a particular research study. 3
Clinical Trials Clinical trials are research studies of new therapies. Before a new therapy can be accepted for routine use, its effectiveness and safety must be proven in clinical trials. Speak with a member of your health care team to see what trials for breast cancer would be suitable for you to consider. Will there be side effects and what can I do about them? The type and severity of side effects you may experience will depend on a number of factors, especially the type of treatment you receive. You will be given verbal and written information about your treatment and potential side effects and your doctors and nurses will be happy to answer any questions you may have. You will be given contact information in case you have any concerns in between treatment visits. Surgery Most patients who have breast surgery find that they recover relatively quickly and feel very little discomfort. Medication will be given to control pain as required. If the surgery includes breast reconstruction, there may be more significant side effects because the surgery is more extensive. In all cases, the treatment team provides support to help manage the physical side effects of surgery, but they also will ensure that you are coping with the emotional impacts of this surgery as well. Radiotherapy Radiotherapy may cause your skin to become dry and reddened (like a mild sunburn) in the area that is being treated. Your treatment team will monitor this closely and provide information to manage the effects to your skin. The other common side effect of radiotherapy is fatigue, which can usually be managed by balancing your activity levels, taking gentle exercise regularly, and making time to rest as required. Chemotherapy The side effects of chemotherapy will depend on the type of drugs that are used, but they can usually be well controlled. Your treatment team will give you information about the specific drugs that will be used for your treatment once this has been decided. You also will be given support and tips to help cope with any side effects, including fatigue that can develop over the course of your treatment. Nausea is another common side effect of many chemotherapy regimes, but medication successfully controls nausea in the majority of instances. Most chemotherapy regimes do involve hair loss and if you wish, you will be fitted with a wig of your choice before this occurs. Is my doctor a specialist in my type of cancer? All breast cancer surgery in South East Scotland is performed by specialist breast surgeons who have received expert training in this field. 4
If you will be receiving chemotherapy for breast cancer, the consultant in charge of your case will be an oncology consultant who is a specialist in chemotherapy for breast cancer. This consultant will prescribe the chemotherapy and monitor your ongoing treatment. Decisions about hormone therapy are made collectively by the specialist multidisciplinary team, but the treatment itself may be prescribed by either your surgeon or oncologist. If you will be receiving radiotherapy, your doctor will be a specialist consultant who has received expert training in this field. Who will give me my chemotherapy and will they have the right training? Nurses who are trained in delivering chemotherapy and providing support will give the chemotherapy drugs, which are usually injected into a vein in the arm. The specialist doctor in charge of your chemotherapy treatment will monitor your treatment to ensure you are coping well. Who will give me my radiotherapy and will they have the right training? Radiographers who specialise in the treatment of cancer will provide the treatment, information, and support throughout the course of radiotherapy. Both medical and nursing staff are available if required during treatment. If I have to go to more than one clinic or hospital, will they know about my diagnosis and treatment? There are formal arrangements in place between the different departments, clinics, and hospitals to ensure that your full records will be available to all the staff that will be involved in your care. Who will arrange for any drugs or equipment I may need when I leave hospital? At the time of your admission to hospital, the nursing staff on the ward will make arrangements for the supply of any required drugs or equipment you may need once you have been discharged from hospital. What do I do if I need help overnight or at the weekend? You will be given contact information for the ward, which you can contact if you have a significant problem during the night or on weekends. If you have any additional concerns, please do not hesitate to discuss this with the nursing staff on your ward so that any additional arrangements can be made prior to your discharge from hospital. During your first meeting, your specialist nurse will give you contact information so that you can discuss with her any problems or concerns you may have in between hospital appointments. 5
*Note: These questions are based on a series of standards against which NHS Quality Improvement Scotland (formerly the Clinical Standards Board for Scotland) measures the quality of patient care in Scotland. For each breast cancer standard, the NHS Quality Improvement Scotland prepared relevant questions that patients might want to ask about their care. The answers presented here by the South East Scotland Cancer Network (SCAN) Breast Cancer Group are generic answers about the services provided across Fife, Lothian, Borders, and Dumfries & Galloway. For more information on the SCAN or NHS QIS Standards: South East Scotland Cancer Network http://www.scan.scot.nhs.uk NHS Quality Improvement Scotland http://www.nhshealthquality.org Reviewer: Matthew Barber Review Date: September 2014 6