ABSTRACTS S15

Background: Up to 40% of women over 70 are treated with Primary

Endocrine Therapy (PET) as an alternative to surgery in the UK although

this rate varies widely by region. This may be due to variation in clinician

preference for either treatment. There is little published on the impact of

healthcare professional (HCP) preference on treatment choice in elderly pa-

tient with early breast cancer. Thismixed qualitative and questionnaire study

has explored the underpinning reasons for variation in treatment practices.

Methods: Semi-structured interviews were undertaken with HCPs

from regions with high, medium and low rates of PET. Factors influencing

treatments offered were explored. Interviews were recorded, transcribed

verbatim and Framework analysed. A questionnaire was developed to

quantify themes raised during the interviews and disseminated to 641

HCPs via the UK Association of Breast Surgeons.

Results: Thirty-four HCPs (20 breast surgeons; 13 nurse specialists; 1

geriatrician) were interviewed from 14 sites across the UK and 192 question-

naires returned within 6 weeks (30%). There was an overriding feeling that

the definition of ‘old’ has changed with many suggesting that PET was not

suitable for patients under the age of 80 unless there are significant comorbid-

ities, however it was clear that age remains an important factorwhendeciding

treatment in these patients with 150/192 (78.1%) stating that age has at least

some importance in the decision making process. The opinion was split

regarding the best way to treat patients with dementia, with 78/192

(40.7%) of respondents agreeing with the statement ’Patients with dementia

should be treated with PET’ and 110/192 (57.2%) disagreeing. Patient pref-

erence was generally stated as the most important factor when considering

treatment options with 179/192 (93.2%) stating it was either important or

very important. However opinions differed on whether a choice of the two

treatments should be given, with over a quarter (50/192; 26.1%) believing

that all patients over the age of 70 should be offered PET and 152/192

(79.1%) believing that all patients over 70 should be offered an operation.

Conclusions: Opinions differ on the best way to treat women over 70,

especially if they have co-existing dementia, as well as whether they

should be offered PET as a treatment option. This may be a significant

cause of the variation in treatment of women over 70 in the UK.

Conflict of interest: Other substantive relationships: This abstract presents

independent research funded by the National Institute for Health Research

(NIHR) under its Programme Grants for Applied Research Programme

(Grant Reference Number RP-PG-1209-10071). The views expressed are

those of the author(s) and not necessarily those of the NHS, the NIHR

or the Department of Health.

http://dx.doi.org/10.1016/j.ejso.2014.08.011

14. Repeat sentinel node biopsy in recurrent breast cancer: Additional

staging information and factors associated with technical success

G. Vugts1, A.J.G. Maaskant-Braat1, R.M.H. Roumen2, E.J.T. Luiten3,

E.J.T. Rutgers4, A.C. Voogd5, G.A.P. Nieuwenhuijzen1

1 Catharina Hospital, Surgery, Eindhoven, Netherlands2Maxima Medical Centre, Surgery, Veldhoven, Netherlands3Amphia Hospital, Surgery, Breda, Netherlands4Netherlands Cancer Institute, Surgery, Amsterdam, Netherlands5Maastricht University, Epidemiology, Maastricht, Netherlands

Introduction: Knowledge of regional lymph node involvement could

provide additional information in patients with recurrent breast cancer in

order to achieve better locoregional control and predict prognosis. Stan-

dard axillary staging in patients with recurrent breast cancer is no axillary

procedure in patients with prior axillary lymph node dissection (ALND)

and ALND in patients with a prior sentinel node biopsy (SNB). The

‘Sentinel Node and Recurrent Breast Cancer (SNARB)’ study is a Dutch

nationwide registration study to assess feasibility and validity of perform-

ing repeat SNB in patients with locally recurrent breast cancer.

Methods: A total of 255 patients diagnosed with locally recurrent non-

metastatic breast cancer underwent lymphatic mapping (LM) and SNB in

24 Dutch hospitals.

Results: A total of 88 patients underwent breast conserving surgery

(BCS) with SNB, 131 patients BCS with ALND and 25 patients mastec-

tomy, of which 14 with SNB and 11 with ALND as their primary proce-

dure. Another 11 patients underwent BCS without axillary surgery. In

148 patients (58%) a sentinel node (SN) was identified and in 122 patients

(47.8%) the SN was successfully removed. Aberrant drainage patterns

were visualized in 50% of patients, more frequently after previous

ALND (74.7%) than after previous SNB (25%, P < 0.001). In 19 patients

(15.6%) (micro)metastases were found in the SN. Overall, the result of this

repeat SNB led to a change in the adjuvant treatment plan in 11.5%. Addi-

tionally, 47 patients (46.1%) with a previous negative SNB were spared an

ipsilateral ALND due to a negative repeat SNB. Technical success of

repeat SNB was influenced by several factors. Patients with successful

repeat sentinel node visualization were injected with a higher amount of

99m technetium-nanocolloid (Tc-99)(P ¼ 0.010). The identification rate

was 32.8% after subareolar injection of Tc-99, 64.2% after periareolar in-

jection in the quadrant of the tumor and 67.2% after peritumoral injection.

LM in a two-day protocol was successful in 64.3%, versus 48.8% in a one-

day protocol (P¼0.016).

Conclusion: Repeat SNB is technically feasible and provides staging

information in patients with locally recurrent breast cancer, leading to

changes in management. Aberrant drainage patterns are observed in 50%

of patients. Technical success is achieved more often when more Tc-99

is injected and when LM is performed in a two-day protocol. Subareolar

Tc-99 injection appears to be inadequate in repeat SNB.

At the time of presentation at ESSO in October 2014, the total amount of

included patients in the SNARB Registration Study is expected to be 450.

No conflict of interest.

http://dx.doi.org/10.1016/j.ejso.2014.08.012

15. Long term effects of extended adjuvant endocrine therapy on

quality of life in breast cancer patients

M. Kool1, D.B.Y. Fontein1, W.M. Meershoek-Klein Kranenbarg1,

J.W.R. Nortier2, E.J.T. Rutgers3, P.J. Marang-van de Mheen4,

C.J.H. van de Velde1

1 Leiden University Medical Center, Surgery, Leiden, Netherlands2 Leiden University Medical Center, Medical Oncology, Leiden,

Netherlands3Netherlands Cancer Institution, Surgery, Amsterdam, Netherlands4 Leiden University Medical Center, Medical Decision Making, Leiden,

Netherlands

Background:Prolongingadjuvant endocrine therapy for hormone-recep-

tor positive, postmenopausal early breast cancer patients improves disease-

free survival. However, endocrine therapymay have adverse events, resulting

in reduced quality of life (QoL). The IDEAL study (BOOG 2006-05) investi-

gates the optimal duration of letrozole after 5 years, the IDEAL QoL side-

study investigates the impact of this extended therapy on QoL.

Methods: A representative sample of 468 patients, selected from the

TEAM trial were invited to fill in a questionnaire 6-6,5 years after diag-

nosis. The questionnaires comprised the EORTC QLQ-C30 and BR23.

QoL among long term survivors was compared with the general population

and with previous reports from breast cancer patients.

Results: Response was 72%. Patients receiving extended adjuvant

endocrine therapy reported significantly better global QoL compared

with general population (80 versus 71; p < 0.01) and breast cancer patients

(80 versus 65; p < 0.01). Similar results were found on 8 other scales.

They scored worse on insomnia, body image and sexual enjoyment. Pa-

tients who sometimes forget their medication have the best QoL (84 versus

79; p < 0.01). More detailed results on the impact of compliance and life-

style factors will be shown.

Conclusion: Breast cancer survivors receiving extended adjuvant

endocrine therapy have a significantly better long term QoL compared

with the general population.