165. Can we safely avoid axillary clearance when sentinel node is minimally involved in early breast cancer?

Background: In the UK there has been a nationwide movement towards patient led follow up care after breast cancer treatment. This open access follow up has been found to be more effective, enabling cancer survivors to take control of their condition and get on with their lives. This study aimed to assess the impact of an open access follow up system for breast cancer patients at East Surrey hospital. Instead of a routine appointment, follow up patients with a benign mammogram would be given open access telephone contact with breast care nurses and offered a hospital appointment only when necessary. Materials and methods: Mammogram results were reviewed for follow up breast cancer patients attending clinic for their annual review. Results were divided into those reported as benign and those as indeterminate or suspicious. Patient selection for entrance to open access was determined by questionnaire consent. Following the introduction of open access, breast care nurses monitored phone calls received over a one month period. Questionnaires were used to grade the appropriateness of the queries and any actions required to resolve them. Results: Of 100 clinic encounters analysed, 69 had mammograms that were reported as benign and 31 as indeterminate or suspicious. On average, 2080 breast cancer patients are seen in follow up clinics at East Surrey hospital per annum. Of these approximately 69%, or 1435 patients, will have a benign mammogram. Following introduction of open access, an increase in call volume was reported by breast care nurses. However, further analysis showed that 98% of telephone encounters were entirely managed by breast care nurses and none required a hospital appointment. The cost of a single follow up clinic appointment is £150, so £215,250 per year is spent at East Surrey hospital on patients who may not have needed to attend. Conclusions: This study demonstrated that open access follow up provided adequate and timely support for patients after breast cancer treatment, while simultaneously preventing unnecessary hospital attendances. Furthermore, there are clear financial benefits to the introduction of open access follow up for this patient group. As a result, open access is being proposed by the East Surrey Breast Unit for follow up patients with a benign mammogram. Further analysis is needed to evaluate the long term impact. Nevertheless, the initial results are promising. No conflict of interest.