Day surgery for breast cancer: a pilot randomised controlled trial.

Abstract

Abstract Abstract #5090 Background: Over the past 10 years, surgical management of Breast Cancer has undergone a huge change. More patients are now treated by breast conserving surgery (BCS) and lesser axillary surgery. Therefore, great potential exists to carry out Breast Cancer surgery in day surgery (DS) setting. However, at present few centres in the United Kingdom are practicing this.
 The objectives of the present study were: (i) to review the evidence in literature, (ii) analyse current practice and (iii) conduct a pilot randomised controlled trial (RCT) comparing DS and inpatient surgery (IS) for patients undergoing BCS for Breast Cancer.
 Methods:
 (i) A systematic review of literature searching DS for breast cancer was performed using standard search tools.
 (ii) Age, treatment and length of stay information about all breast patients admitted at a tertiary centre from March, 07 to Jan, 08 was prospectively collected.
 (iii) Newly diagnosed breast cancer patients undergoing BCS with axillary sampling who had passed the DS preassessment were randomised to DS or IS. Physical and psychosocial outcomes were assessed using a Surgical Site Infection Form (Day 7 and Day30), FACT-B questionnaire (Baseline, Day7 and Day30) and a Patient Diary for the first post-operative week.
 Results:
 (i) No RCTs were found in the literature. Ten observational studies describing DS for breast cancer were included. Seven of these found DS to be safe with equivalent complications to IS and 3 highlighted its economic benefits. Only 1 study used a validated psychological distress scoring system and found results in favour of DS.
 (ii) Over the 10-month period there were 288 breast cancer operations. Of these, only 112 (38.9%) stayed in the hospital for > 23 hours. Hence, it would be ideal to consider breast cancer for DS.
 ((iii) There were 18 patients in the pilot RCT; 11 in the DS arm and 7 in the IS arm.
 Physical outcomes: There were no significant differences in pain, nausea or vomiting scores and infection rates. Patients in the DS group mobilised and stepped out of their house earlier (Day2 vs. Day4) after surgery and also more frequently (4 days vs. 3 days) in the first week than the IS group.
 FACT-B: Longitudinal differences in overall FACT B scores obtained on Day 7 and Day 30 compared to Baseline scores are detailed in Table1. A difference of > 5% was considered significant.
 
 Conclusions: Systematic review of literature showed DS to be safe for the patient but there is lack of evidence in the form of RCTs.
 This pilot RCT shows that DS patients mobilise earlier and have equivalent results for the other physical outcomes. FACT-B scores suggest better quality of life a week after surgery in the DS group.Larger RCTs are needed to support these results. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5090.