Browsing by Author "Cairncross, Lydia"
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- ItemOpen AccessA Clinical Approach to Common Surgical Scenarios: A Handbook for Students and Junior Doctors(The Authors, 2020-01) Panierie, Eugenio; Cairncross, Lydia; Boutall, Adam; Bernon, Marc; Malherbe, Francois; Panieri, Eugenio; Malherbe, FrancoisAimed at students and junior doctors, the purpose of this book is to provide a guide to the evaluation of common surgical problems as well as test diagnostic and troubleshooting skills when there is nobody to help or ask for advice.
- ItemOpen AccessContraceptive needs and fertility intentions of women with breast cancer in Cape Town, South Africa: a qualitative study(2020-10-06) Harries, Jane; Constant, Deborah; Cairncross, Lydia; Moodley, JenniferBackground: No known studies have been undertaken in South Africa exploring the contraceptive and fertility needs and preferences of women of reproductive age (18–49) diagnosed with breast cancer. This study set out to understand the contraceptive needs and fertility intentions of women with breast cancer in Cape Town, South Africa. Methods Qualitative in-depth interviews were conducted with 24 women diagnosed with breast cancer and 4 health care providers at a tertiary hospital in Cape Town, South Africa. We explored contraceptive use prior to diagnosis; the impact of breast cancer on future fertility intentions and contraceptive use; understanding of suitable contraceptive methods during and after treatment and women’s fertility related counseling needs during their continuum of care. Data were analysed using a thematic analysis approach. Results Since being diagnosed with breast cancer, of those women using a contraceptive method, the non-hormonal intrauterine device (IUD) was the most commonly used method. However, women reported receiving limited information from health care providers about contraceptive use and future fertility planning post treatment when fertility desires might change. Many women reported limited information received from healthcare providers about the impact of cancer treatment on their future fertility. Most women did not receive information around fertility preservation options, and few were familiar with the concept. Providers focus was more on preventing pregnancy during treatment and ensuring a patient was on a non-hormonal contraceptive method. Providers supported a more holistic, multidisciplinary approach to breast cancer patient’s contraceptive and future fertility needs. Conclusions Limited contraceptive and future fertility counseling were reported by women despite many women being provided with the IUD. There is a need for improved information and counseling regarding the impact of treatment on contraceptive and fertility options. It is important that cancer care providers provide timely information regarding fertility options and communicate with patients about their fertility concerns prior to treatment and throughout the course of survivorship. The development of evidence-based information tools to enhance patient-provider communication and counseling could address knowledge gaps.
- ItemOpen AccessFrom symptom discovery to treatment - women's pathways to breast cancer care: a cross-sectional study(BioMed Central, 2018-03-21) Moodley, Jennifer; Cairncross, Lydia; Naiker, Thurandrie; Constant, DeborahBackground Typically, women in South Africa (SA) are diagnosed with breast cancer when they self-present with symptoms to health facilities. The aim of this study was to determine the pathway that women follow to breast cancer care and factors associated with this journey. Methods A cross-sectional study was conducted at a tertiary hospital in the Western Cape Province, SA, between May 2015 and May 2016. Newly diagnosed breast cancer patients were interviewed to determine their socio-demographic profile; knowledge of risk factors, signs and symptoms; appraisal of breast changes; clinical profile and; key time events in the journey to care. The Model of Pathways to Treatment Framework underpinned the analysis. The total time (TT) between a woman noticing the first breast change and the date of scheduled treatment was divided into 3 intervals: the patient interval (PI); the diagnostic interval (DI) and the pre-treatment interval (PTI). For the PI, DI and PTI a bivariate comparison of median time intervals by various characteristics was conducted using Wilcoxon rank-sum and Kruskal-Wallis tests. Cox Proportional-Hazards models were used to identify factors independently associated with the PI, DI and PTI. Results The median age of the 201 participants was 54 years, and 22% presented with late stage disease. The median TT was 110 days, with median patient, diagnostic and pre-treatment intervals of 23, 28 and 37 days respectively. Factors associated with the PI were: older age (Hazard ratio (HR) 0.59, 95% CI 0.40–0.86), initial symptom denial (HR 0.43, 95% CI 0.19–0.97) and waiting for a lump to increase in size before seeking care (HR 0.51, 95% CI 0.33–0.77). Women with co-morbidities had a significantly longer DI (HR 0.67, 95% CI 0.47–0.96) as did women who mentioned denial of initial breast symptoms (HR 4.61, 95% CI 1.80–11.78). The PTI was associated with late stage disease at presentation (HR 1.78, 95% CI 1.15–2.76). Conclusion The Model of Pathways to Treatment provides a useful framework to explore patient’s journeys to care and identified opportunities for targeted interventions.
- ItemOpen AccessPatient reported outcome measures (PROMs) in breast cancer patients after immediate breast reconstruction using the Breast-Q(2020) Möller, Ernst Lodewicus; Cairncross, Lydia; Panieri, Eugenio; Hudson, DonaldBackground Mastectomy is the mainstay of surgical treatment for women with breast cancer in South Africa. The increase in breast reconstruction after a mastectomy has prompted the need to evaluate patient reported outcome measures (PROMs) for this set of operative intervention. This study aimed to assess clinical and patient reported outcome measures in immediate breast reconstruction patients using the BREAST-Q and compare these with international cohorts. Methods A cross-sectional study was performed on all patients who underwent immediate breast reconstruction between January 2011 and December 2016. This consisted of a retrospective clinical record review of perioperative outcomes, and a quality of life analysis using the BREAST-Q Post-Reconstruction questionnaire. Outcome predictors were identified using Chi-square, Fisher exact, One-way ANOVA, Student t-tests and Kruskal Wallis analysis of variance. A random-effect single arm meta-analysis was performed to compare the BREASTQ scores with international cohorts. Results A total of 52 patients were included with a mean age of 43.2 (+/-9.5) years. Eighteen patients (34.6%) developed early complications; of these 8 (44.4%) were major. Thirty-one patients (59.6%) developed late complications; of these 18 (58.1%) were major. Fifteen patients (28.8%) had failed reconstruction. There was a significantly higher risk of failure following a total mastectomy (TM) (p=0.02), tissue expander reconstruction (TE) (p< 0.01) and stage 2 breast cancer (p=0.01). Patients who underwent nipple reconstruction and immediate-delayed reconstruction before 12 months, reported higher well-being and satisfaction scores. Compared to international cohorts our BREAST-Q scores were lower but fall within the 95% confidence interval for Sexual Well-Being and Satisfaction with Nipples and Care. Conclusion Immediate breast reconstruction poses a high risk of complications and reconstructive failure especially, with TM and TE. Our BREAST-Q scores are comparable to international studies and may be useful in guiding patient consent.
- ItemOpen AccessPre-operative diagnosis of thyroid cancer: Clinical, radiological and pathological correlation(2013) Cairncross, Lydia; Panieri, EugenioAIM: Ultrasonography and fine-needle aspiration biopsy (FNAB) are the mainstays of diagnosing thyroid cancer accurately and reducing the number of diagnostic lobectomies. No benchmark for diagnostic accuracy has been published in the South African context. This single-institution study addresses this deficit. METHODS: The oncology, pathology and surgical records of all patients diagnosed with thyroid carcinoma from 2004 to 2010 at Groote Schuur Hospital, Cape Town, South Africa, were reviewed and data were recorded on a standardised confidential proforma. The findings on pre-operative clinical assessment, ultrasound and FNAB were correlated with the histopathology results. Diagnostic accuracy for thyroid cancer was determined by correlating pre-operative investigations with the final diagnosis. Sensitivity of ultrasound and FNAB were calculated. RESULTS: A total of 109 patients, 79 female and 30 male, were identified. The majority (99, 90.8%) had well-differentiated thyroid cancers (56 papillary, 30 follicular, 10 mixed and 3 Hurtle cell carcinomas). There were 6 anaplastic and 4 medullary carcinomas. Of the 109 patients 38 had a definite pre-operative diagnosis, in 61 a malignant tumour was suspected, and 10 had surgery for benign disease. FNAB was inadequate in 11 cases and the findings indicated a benign lesion in 47, a suspicious lesion in 13 and a malignant lesion in 38 patients diagnosed with thyroid carcinoma. FNAB diagnosed all patients with medullary and anaplastic carcinoma but less than half of those with well-differentiated thyroid carcinoma. Ultrasound scans detected at least one suspicious feature in 44 patients. Microcalcification was the most common sign. CONCLUSION: The rate of pre-operative diagnosis of well-differentiated thyroid carcinomas in this unit is under 50%, well below international norms. Our standard practice needs to change to include ultrasound-guided FNAB and standardised reporting of high-resolution ultrasound and cytology, before reassessment of our diagnostic accuracy.
- ItemOpen AccessPre-operative localization and surgical outcomes for primary hyperparathyroidism (PHPT): An 11-year review at a South African hospital(2018) Van Wyngaard, Tirsa; Cairncross, LydiaIntroduction: Primary Hyperparathyroidism (PHPT) is characterized by hypersecretion of PTH leading to hypercalcaemia with successful surgery being the only definitive cure. Broadly, three techniques of parathyroidectomy exist: open bilateral neck exploration and minimally invasive parathyroidectomy, which is subdivided into open focused approaches and endoscopic focused approaches. A focused parathyroid gland exploration guided by pre-operative imaging is associated with less morbidity compared to a bilateral approach. Focused explorations may target either the side or the specific parathyroid gland identified. Aim: The primary aim of this study was to evaluate the accuracy of pre-operative localisation for PHPT in a single centre. The secondary aim was to review the type of parathyroid surgery performed and the final Parathyroid Hormone (PTH) levels in patients who have undergone parathyroidectomy for PHPT. Methods: This is a retrospective review of all patients who underwent primary surgery for PHPT between 2005 and 2015. Patients were identified from a general operative database. Data was collected from pathology records, operative notes, nuclear medicine and radiology reports and captured on a confidential data sheet. Results: Records of 98 patients were found and included. Sestamibi had a sensitivity of 88%, a positive predictive value of 83% and an accuracy of 75%. Ultrasound had a sensitivity of 52%, a positive predictive value of 78% and an accuracy of 44%. The total number of cases in which both ultrasound and sestamibi were done was 73. Sestamibi and ultrasound showed concordant results in 25 cases. The overall surgical success rate was 94% (92/98). The cure rate for patients in whom sestamibi and ultrasound were concordant, was 96% (24/25). The minimum and maximum calcium levels in the cohort were 2.2 and 4.41 respectively, with a mean of 2.86. PTH levels ranged between 4.2 and 186 with a mean of 33.8. One double adenoma was proven on histology. The rest were all single adenomas. The total number of malignancies were 3 of which 1 was part of a MEN syndrome. Conclusion: Our surgical success rate was 94%. When imaging modalities were concordant, surgical success was achieved in 24 cases, thus in 96% of the subgroup. Our figures compare favourably with international standards. There is scope for improvement in the accuracy of both ultrasound (46%) and sestamibi (75%) localization. Currently a combination of both imaging modalities is still recommended.
- ItemOpen AccessThe management of desmoid tumours at Groote Schuur Hospital: A retrospective review of current practice(2019) Pickard, Henri Du Plessis; Cairncross, Lydia; Panieri, EugenioBackground: Desmoid tumours (DTs) are rare soft tissue tumours that do not metastasise but are locally aggressive. Management options are varied and the response to treatment can be unpredictable. Aim: The aim of this study was to describe the clinical presentation, management strategies and outcomes for adult patients who were treated for DT. Setting: The study was conducted at Groote Schuur Hospital in Cape Town, South Africa and all patients from 2003 to 2016 who presented with DT were included. Method: This was a retrospective review of records. Data collected included: demographics, DT-associated conditions, site and size of tumour, histological findings, treatment modalities, follow-up and outcomes. Results: Seventy patients with histologically confirmed DT were identified. The majority were women (86%) and 77% presented with a painless mass. The commonest site was the anterior abdominal wall (47%). Definitive surgery was performed in 46 (66%) patients, whereas 13 (19%) had definitive radiotherapy. Nine patients received adjuvant radiotherapy post-surgery for involved or close margins. Recurrence developed in 20% patients post-surgery. In the primary radiotherapy group, one patient had disease progression. Two patients with mesenteric DT died because of bowel obstruction. Conclusion: This retrospective review of patients affected by DT at a single centre demonstrates the rarity of the condition, the unpredictable natural history and the variety of treatment options available. Many of our findings are similar to other published studies, except the mean size of DT which was bigger. Treatment outcomes following surgery or radiotherapy seem acceptable, although study limitations are noted.