Dr Muireann Kelleher - Parkside Hospital
Dr Muireann Kelleher - Parkside Hospital
Dr Muireann Kelleher - Parkside Hospital
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<strong>Dr</strong> <strong>Muireann</strong> <strong>Kelleher</strong> MB BCh BAO MRCP PhD<br />
Consultant Medical Oncologist with a special interest in Breast Cancer<br />
Cancer Centre London, <strong>Parkside</strong> and St George’s NHS Trust
Cancer beyond the breast and ipsilateral<br />
axillary nodes<br />
Lymph nodes in contralateral axilla =<br />
metastatic disease<br />
<br />
Favoured sites; bone, liver, lungs , brain,<br />
cutaneous
Incurable ≠ imminently terminal<br />
Life-long illness<br />
Chronic disease: durable clinical response<br />
<br />
Few patients have an inexorable rapid decline
Early diagnosis of primary breast cancer (screening)<br />
Optimal surgery<br />
Adjuvant systemic therapy<br />
Radiotherapy<br />
<br />
<br />
Weight and lifestyle<br />
Impediments to accessing cancer care in local<br />
boroughs
38 year old<br />
• 3.5cm tumour<br />
• Grade II<br />
• Node negative<br />
• ER+ve
Right drug, right patient, right cancer.
High cost of adjuvant trastuzumab (Herceptin®)<br />
Less metastatic breast cancer<br />
Less expensive second-line treatment<br />
Less acute toxicity<br />
More patients working, supporting their families<br />
= very cost effective<br />
<br />
High yields outweigh the initial cost
High quality biomarkers are available now<br />
OncotypeDx<br />
£3,500<br />
IHC4<br />
Ki67 < £100
Initial symptoms more often first present to<br />
primary care<br />
This will increasingly be the case<br />
<br />
<br />
Reduced follow-up<br />
OAFU
Guage the tempo of the disease<br />
Biopsy so that you can target the target<br />
<br />
Right drug, right patient, right cancer.<br />
<br />
<br />
<br />
<br />
Therapeutic Index<br />
ECOG PS<br />
Patient expectations wishes and investment<br />
Finances
Coordinate community, social & palliative care<br />
<br />
Early palliative care input<br />
<br />
Wrap services around the needy<br />
<br />
GP- hospital relationships<br />
<br />
Patients and their families: untapped resource<br />
Educate and empower to enable self-management
Early diagnosis (screening)<br />
Optimal surgery<br />
Adjuvant systemic therapy<br />
Radiotherapy<br />
<br />
Weight and lifestyle
Overweight woman with a prior diagnosis of<br />
ER positive breast cancer: the value of loosing<br />
10% of body weight is equivalent to the<br />
impact of adjuvant hormone therapy<br />
<br />
Slow realistic weight loss is life changing and<br />
life saving
<strong>Dr</strong> <strong>Muireann</strong> T <strong>Kelleher</strong><br />
Cancer Centre London<br />
49 <strong>Parkside</strong><br />
Wimbledon<br />
SW19 5NB<br />
email: muireann@kelleher.org.uk<br />
Appointments 020 8247 3380<br />
Secretary: Ms Rhiannon Pottinger<br />
Tel 020 87252955<br />
Fax 020 87251199
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