Letters / Clinical Oncology 22 (2010) 84–88 87

There has been an increase in doctors being contactedout of hours (when not on call) over the past 2 years. Beingcontacted after 5 pm on week days was universal for allconsultants and registrars in 2006 and remains so now. Allconsultants and 80% of registrars report being contacted atthe weekend, an increase from 92 and 50%, respectively.This raises the issue as to whether we are duty bound torespond to ‘urgent’ messages left when not on call. No clearguidelines exist, although our experience suggests thatmost people do respond. Specialist nurses, most of whomown Trust mobile phones, leave voicemail messages whennot on duty with contact numbers for emergencies. Thissupports the issue of National Health Service Trust-issuedmobile phones, which would allow users to leave an ‘out ofoffice’ message when not at work, removing the obligationto respond to messages left when not on duty.

Ten staff (35%, three consultants and seven clinical nursespecialists) had been issued with a National Health ServiceTrust mobile phone and had their bill paid by the Trust. Ofthe 19, mostly doctors, who used their own mobile phone,26% paid more than £10 per month on work-related callsand text messages and 42% paid between £5 and £10. OurTrust will issue mobile phones to regular users for Trustbusiness, although this is not widely publicised. Consider-ation should be given to fund mobile phones for all clinicalstaff, particularly those who work off site.

Increasing mobile phone use within our departmentreflects changes in society as a whole. Previously, use withinhospitals was restricted due to concerns of interferencewith medical equipment. Recently, regulations have beeneased [1] as evidence has shown that this effect is weak [2].In contrast to pagers, which are issued by the employinghospital, mobile phone use seems to be a practice that hasevolved insidiously without ‘official’ recognition. Althoughthe advantages are obvious, this study has highlighted somedisadvantages associated with this practice, namely costand intrusion into staff off duty. There is a need for guide-lines to ensure that use is funded and that staff are con-tacted appropriately.

R.E. Miller, S. Boyce, J.S. WhelanDepartment of Oncology, University College Hospital, 1st Floor

Central, 250 Euston Road, London NW1 2PW, UK

References

[1] Medical Devices Agency. Electromagnetic compatibility ofmedical devices with mobile communications, 1997. DeviceBulletins DB9702 and DB1999.

[2] Lawrentschuk N, Bolton DM. Mobile phone interference withmedical equipment and its clinical relevance: a systematicreview. Med J Aust 2004;181:145–149.

� 2009 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

doi:10.1016/j.clon.2009.11.001

Breast Cancer Multidisciplinary Team Adjuvant Therapy Decision Makingand Adjuvant! Online

Sir d Adjuvant therapy in early breast cancer reduces therisk of recurrence and death [1], but the process of adjuvanttherapy decision making by multidisciplinary teams (MDTs)varies; some use prognostic indices, such as the NottinghamPrognostic Index, whereas many others do not [2]. There arenow different tools and ‘decision aids’ to help the decisionmaking process [3], such as Adjuvant! Online (www.adjuvantonline.com). The National Institute for Health andClinical Excellence (NICE) in the UK recommends usingAdjuvant! Online in adjuvant therapy decision making [4].

We studied the adjuvant endocrine therapy and chemo-therapy recommendations of an MDT in 122 women withearly breast cancer in relation to the 10-year risk of breastcancer death and relapse, and the therapy that would resultin the maximum reduction in these risks calculated for eachwoman using Adjuvant! Online. As different endocrinetherapies only differ in the risk of relapse (and not insurvival) we compared the MDT-recommended endocrinetherapy with the endocrine therapy that resulted in themaximum reduction in the 10-year risk of relapse. Forchemotherapy, we assumed that the MDTshould have offeredchemotherapy where the Adjuvant! Online-estimated risk of

death was�10% and/or the survival benefit by the addition ofchemotherapy was�3%. The survival benefit was calculatedusing a third-generation taxane-containing chemotherapyregimen, as this gave the maximum benefit on Adjuvant!Online.

The MDT recommended endocrine therapy to all patientswith hormone receptor-positive cancers, but 47% of post-menopausal women received tamoxifen rather than anaromatase inhibitor, which resulted in a lower relapse rateon Adjuvant! Online. This was due to both local cancernetwork guidelines and national (NICE) guidelines [5] thatconsidered tamoxifen appropriate for ‘low-risk’ disease.Among patients with �10% risk of death or �3% survivalbenefit, 69 and 79%, respectively, were offered chemo-therapy by the MDT. The main reasons for not offeringchemotherapy to others were advanced age, co-morbidity orboth, except for one suitable patient who was perceived tobe at low risk by the MDT. On the other hand, two relativelyyoung patients with <10% risk of death and <3% survivalbenefit were recommended chemotherapy. Use of the third-generation regimen was low (27%), mainly due to national(NICE) guidelines (www.nice.org.uk/Guidance/TA109) and

Letters / Clinical Oncology 22 (2010) 84–8888

because this regimen was being evaluated in the unit whenthe study started.

We conclude that adjuvant therapy recommendations ofthe MDT broadly agree with Adjuvant! Online estimates.The main reasons for not offering chemotherapy to ‘high-risk’ patients were lack of evidence, as in elderly patients [1],and co-morbidity. The differences in the type of endocrinetherapy and chemotherapy were mainly due to local ornational guidelines, which MDTs take into account in deci-sion making. Using Adjuvant! Online during MDT discus-sions will probably improve the decision making process inonly a minority of patients (2.5%, 3/122 in this study).

V. Nowak, M. Ah-See, D. RavichandranBreast Unit, Luton & Dunstable Hospital NHS Foundation Trust,

Lewsey Road, Luton LU4 0DZ, UK

References

[1] Early Breast Cancer Trialists’ Collaborative Group (EBCTCG).Effects of chemotherapy and hormonal therapy for earlybreast cancer on recurrence and 15-year survival: an over-view of the randomised trials. Lancet 2005;365:1687–1717.

[2] Williams C, Brunskill S, Altman D, et al. Cost-effectiveness ofusing prognostic information to select women with breastcancer for adjuvant systemic therapy. Health Technol Assess2006;10(34):69–89.

[3] Munoz M, Estevez LG, Alvarez I, et al. Evaluation of interna-tional treatment guidelines and prognostic tests for thetreatment of early breast cancer. Cancer Treat Rev 2008;34:701–709.

[4] Avaliable at: http://www.nice.org.uk/nicemedia/pdf/CG80NICEGuideline.pdf.

[5] Avaliable at: www.nice.org.uk/TA112.

� 2009 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

doi:10.1016/j.clon.2009.11.002