HNY Policy and Pathway Repository - Humber

The majority of patients diagnosed with breast cancer will have surgery and adjuvant treatment. For those who have oestrogen or progesterone receptor positive tumours endocrine treatment will form part of the adjuvant therapy.

However there is a small cohort of patients who have oestrogen or progesterone receptor positive tumours in whom surgery is not appropriate:

• Significant comorbidity (may not survive a general anaesthetic)
• Other life limiting conditions
• Patient wishes
• Family wishes if have power of attorney for all medical matters

These patients may be offered palliative treatment with the aromatase inhibitor letrozole.

No Red Flags Listed

Patients with difficulty walking /wheelchair bound and resident in a care home etc require a considerable upheaval for both  patients and carers for a 5 minute hospital assessment. These patients can be followed up by the GP.

If a patient has stable or regressing disease after 1 year of letrozole the GP will follow patients up at their residence/home as below:`

• Patient discharged from secondary care with a discharge summary for GP to follow the primary endocrine follow up.
• GP to assess the patient breast mass clinically yearly with/without callipers in two largest dimensions.
• If there is no progression of disease or regression -continue yearly follow up.
• If progression refer back to breast clinic in secondary care.
• If symptoms of systemic relapse refer to breast clinic

No Referral Criteria/Information Listed