The National Mastectomy and Breast Reconstruction Audit Key findings of the Fourth Annual Report Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

Audit aims To describe provision of mastectomy and breast reconstruction services in England To investigate determinants and outcomes of care for women with breast cancer having a mastectomy with or without breast reconstruction Help in the development of future standards and guidelines in this area. All work is being done on a comparable basis, but at Unit level only. Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

Audit methodology The Audit prospectively enrolled: women with breast cancer who underwent mastectomy or breast reconstruction surgery in the NHS and independent sector in England between 1 January 2008 and 31 March 2009 Data collected from: clinicians on clinical practice and inpatient outcomes patients on treatment options, patient-reported outcomes and experience of care Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

Audit participation – clinical study 18,216 women with complete information: 16,558 treated at English NHS trusts 1,249 treated at independent hospitals 409 treated at non-English NHS trusts that also chose to participate Overall NHS case ascertainment of 81.4% More than two thirds of NHS trusts achieved over 75% case ascertainment Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

Audit participation – PROMs study 10,623 women asked to participate 8,725 (82%) gave their consent 8,159 women sent 3 month questionnaires 6,882 (84%) returned a completed questionnaire 8,536 women sent 18 month questionnaires 7,110 (83%) returned a completed questionnaire Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

Fourth Annual Report Provides data on: Patient characteristics and patterns of care Patient-reported experience, information provision and reconstructive choices Patient quality of life 18 months after surgery Help in the development of future standards and guidelines in this area. All work is being done on a comparable basis, but at Unit level only. Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

High levels of patient satisfaction Over 90% of women were very satisfied with the competence of their consultant surgeon 92% of mastectomy only patients 96% of immediate reconstruction patients 96% of delayed reconstruction patients 85% of women were very satisfied with the professionalism of the clinical team Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

Recommendation 1 NHS trusts and independent hospitals should act to maintain the current high levels of satisfaction with both consultant surgeons and breast cancer teams. Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

Patient decision making and concerns Very satisfied that their consultant surgeon involved them in the decision making process - 75% of mastectomy only patients - 81% of immediate reconstruction patients - 87% of delayed reconstruction patients Very satisfied that their consultant surgeon was available when they had concerns - 69% of mastectomy only patients - 75% in the immediate reconstruction patients - 76% in the delayed reconstruction patients Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

Recommendation 2 NHS trusts and independent hospitals should ensure that women are able to be involved in decision making to the degree that they wish, and that staff are available to address the concerns of women undergoing cancer treatments and complex reconstructive procedures. Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

Informing patients of what to expect A few examples: Around one fifth of reconstruction patients were not satisfied with the size of their reconstructed breast in comparison to their unaffected breast Three quarters of IR and four fifths of DR patients were satisfied or very satisfied with how their abdomen looked following TRAM/DIEP flap reconstruction Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

Recommendation 3 Clinicians should use the summary of the experiences of women undergoing breast reconstruction collected during the Audit to augment information about outcomes obtained from volunteers whose background, cancer treatments and age may differ significantly from the woman making reconstructive decisions. Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

Levels of emotional and sexual wellbeing Feel confident in a social setting most or all of the time 18 months after surgery 77% of mastectomy only patients 85% of immediate reconstruction patients 92% of delayed reconstruction patients Feel sexually attractive when clothed most or all of the time 18 months after surgery 37% of mastectomy only patients 57% of immediate reconstruction patients 68% of delayed reconstruction patients Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

Recommendation 4 Clinicians should inform women undergoing mastectomy that those who underwent breast reconstruction reported higher levels of emotional and sexual well being than those who underwent mastectomy alone. Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

Sufficient reconstructive information and choices In those having delayed reconstruction, higher levels of satisfaction with breast area appearance and sexual wellbeing were attained following free flap reconstruction compared to pedicle flap reconstruction with or without an implant. Both groups reported greater satisfaction than the group that had delayed implant-only reconstruction In those having immediate reconstruction, levels of satisfaction with breast area appearance and emotional and sexual wellbeing following pedicle or free flap reconstruction were greater than those following implant only reconstruction Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

Recommendation 5 NHS trusts and independent hospitals should act to ensure that women in both the immediate and delayed reconstruction settings are provided with sufficient information and choices about the full range of reconstructive options. Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

Overall results of surgery at 18 months Proportion that rated the overall results as excellent or very good: 73% of mastectomy only patients 67% of immediate reconstruction patients 78% of delayed reconstruction patients Proportion that were satisfied or very satisfied with how they looked in the mirror clothed: 83% of mastectomy only patients 90% of immediate reconstruction patients 93% of delayed reconstruction patients Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

Recommendation 6 NHS trusts and independent hospitals should ensure that they continue to attain the excellent results of mastectomy and breast reconstruction surgery reported by patients. Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

Benchmarking using national results The Audit has established local and national baselines for patient satisfaction and quality of life outcomes following mastectomy and breast reconstruction surgery Hospital organisations should refer to their own results, the national average, and the outcomes of high performing organisations in evaluating the care they deliver in future Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

Recommendation 7 The Audit findings represent the first national data of their type, and should be used by NHS trusts and hospital organisations to define a performance benchmark against which their future outcomes may be compared. Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

High achieving organisations in the Audit A number of organisations were found to have results that were significantly better than the national average for particular aspects of care quality and outcomes The results attained at these organisations demonstrate what is achievable, and should be used to help set future targets for care quality and outcomes

Recommendation 8 Those involved in the development of future guidelines on mastectomy and breast reconstruction should refer to the results of high achieving organisations when setting benchmarks for future audit. Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

Thank you for your support and participation Thank you for your support and participation! The four annual reports are available for download at www.ic.nhs.uk/mbr Please e-mail mbr@ic.nhs.uk or call 0113 254 7139 for any general queries or for copies of the Audit reports Please e-mail rjeevan@rcseng.ac.uk if you have any methodological queries or would like to use the RCS patient questionnaires for audit or research Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011