The rate of BCT in Taranaki is low, despite it being offered by surgeons to the majority of patients. Local availability of radiotherapy may increase the BCT rate to a level more consistent with larger centres in New Zealand. Care must be taken to provide neutral patient guidance.

This audit has confirmed that there is an acceptable level of care at Taranaki Base Hospital when compared with those in published work. Elective patients with malignancy have a delay of nearly 6 months between the onset of symptoms and surgery. Patients in Taranaki are more likely to present with an advanced stage of tumour compared with other unscreened populations.

Historically, patients presenting with large, inoperable cancers were treated with radiation therapy alone or radiation therapy followed by surgical resection. The use of systemic therapy in patients with locally advanced breast cancer (LABC) has led to improved disease outcome when compared with surgery or radiotherapy alone. In comparison with operable breast cancer, there is a relative paucity of randomised trials evaluating systemic therapy for LABC. Of the randomised trials published, a statistically significant survival benefit is only demonstrated in a few. The difficulties in performing large randomised trials in LABC relate to several issues. The classification of LABC which includes T3, T4, and N2 disease incorporates a heterogeneous group of patients. There is a variable approach taken by clinicians in terms of the type of pre-operative chemotherapy used, sequencing of locoregional therapy and whether post-operative adjuvant systemic therapy is also given. To date, the efficacy of systemic therapy in LABC has largely been established from results of non-randomised Phase II studies. These studies compare favourably to historical data with higher 5-and 10-year disease-free and overall survival. A common finding in several trials of pre-operative systemic treatment is that the rates of breast conserving surgery is increased and those patient achieving a complete pathological response have superior disease outcomes than those who do not.An overview of trials supporting the current management of LABC will be presented. The objectives and preliminary findings of a multicentre study initiated in Perth for women with LABC will also be discussed. This paper explores the modern concept of Specialist Palliative Care. This includes the gradual and ongoing development of specialist palliative care services in New Zealand, embedded within cancer services and the wider health sector: within the community and the acute care environment. No longer is it accurate to assume that a referral to palliative care indicates that the person is imminently dying or that their care will be transferred to that service as an alternative to any form of continued active treatment. Cancer can be aggressive and unremitting but is increasingly experienced as a chronic illness and patients have concerns and needs that fluctuate over time. Multidisciplinary palliative care must be responsive, flexible and able to assist at "points of need", working together with the referring team. Collaboration across all the medical disciplines and the full health care team is essential and communication between services must be robust so that our care is consistent, unambiguous and patient-centred. Palliative care is as aspect of clinical care that we all practice, every day, sometimes without realising it. We need to continually develop our own skills in symptom control, effective communication and decision-making, as well as exploring the philosophy and ethics of end-of-life care. Accessible, meaningful education in all of these areas is vital. While ...