Recurrence Letter

You have requested that your patient __________________ be assessed at the Cancer Center with a concern of recurrent breast cancer. This letter is provided to inform you and your patient of the processes that will now take place, the reasons for them, and how you can be of further help in expediting best care for your patient.

The following conditions require emergency referral to the oncologist:

Symptom/finding:	Investigation:
back pain with limb weakness, change in sensation,change in reflexes, or loss of bowel/bladder control	emergency referral for possible spinal cord compression
new persistent headache (especially in am, with visual changes, nausea or seizures	urgent referral for possible brain metastases
altered level of consciousness, nausea/vomiting, and/or pain associated with hypercalcemia	urgent referral for management of hypercalcemia

If your patient is having any of the following symptoms we suggest that the identified investigations be arranged and results copied to the Cancer Center:

Symptom/finding:	Investigation:
new mass in breast	mammography +/ - biopsy
rash or nodule on chest wall	biopsy if only site of possible recurrence
palpable lymphadenopathy	biopsy if only site of possible recurrence
new persistent bone pain	bone scan and plain films of affected site(s)
new persistent cough or dyspnea	chest xray
hepatomegaly or pain RUQ	ultrasound/CT Scan of abdomen,liver enzymes
other symptom(s)/ finding(s)	dependent on specific problem(s)

If the results of these investigations are suggestive of recurrent disease, a breast oncology nurse will schedule the patient's case for discussion in the Breast Cancer Recurrence Rounds. This is a multidisciplinary case-based conference involving medical oncology, radiation oncology, radiology, and nursing. The nurse may request and facilitate further investigations prior to these rounds if appropriate. A brief referral letter from you outlining the patient's current symptoms, co-morbidities, functional status, and expectations would provide very valuable information for these rounds.

In these multidisciplinary rounds we are able to determine the most appropriate consultation for the patient (medical or radiation oncology), whether further investigations should be planned immediately, and what treatment options(including clinical trials), might be most appropriate for the patient. After the patient's case is discussed in Recurrence Rounds, you or your patient will be contacted by telephone with regards to timing of the patient's scheduled appointment and/or any further investigations. Scheduling is based on clinical urgency.

If you have any concerns with this process or have other concerns with regards to your patient's condition, please do not hesitate to contact us. You can reach the booking nurse at (CCI) 780-432-8732 or contact one of the oncologists directly through the switchboard (CCI) at 780-432-8771.