The Role of Multidisciplinary Breast Cancer Clinics

L’importance des cliniques du sein : document envoyé par Europa Donna Belgium au Parlement Européen en novembre 2002.

Fabienne Liebens MD

Introduction

Breast cancer is the commonest cancer and the most frequent cause of cancer death in women throughout Europe. Among oncologic conditions, breast cancer has one of the most extensive scientific literatures to support an association between processes of care and outcomes. Effective interventions exist for breast cancer that decrease mortality and improve quality of life. In addition, the evidence from the scientific literature suggests that all phases of the continuum of care have an important effect on breast cancer outcomes, including early detection, diagnostic evaluation, and treatment. This extensive clinical literature with many well-designed randomized, controlled trials provides firm grounding for the development of process and outcomes measures of quality of care. Although areas of controversy remain, there is generally a broad consensus on the appropriate screening, diagnostic, and treatment strategies for breast cancer. It is then perhaps not surprising that most of the patterns of care studies in oncology have focused on breast cancer.
Because of its importance and its potential for successful treatment, breast cancer deserves special attention and effort. However, it is difficult to escape the conclusion that a substantial number of women who present with breast cancer receive suboptimal care.

Consequences of multidisciplinary breast cancer clinics (MDBCC)

The benefits of establishing a multidisciplinary breast clinic are clearly demonstrated.

Satisfaction

Many studies point out the positive effects of a multidisciplinary team approach in which a concerted effort is placed on providing information and psychosocial support for breast cancer patients. Women treated in multidisciplinary breast clinics reported significantly higher levels of physical function and satisfaction with their health, physician, and nursing care. Furthermore the MDBCC increased patient satisfaction by encouraging involvement of patients' families and friends and by helping patients make treatment decisions. The time between diagnosis and the initiation of treatment was also significantly decreased.

Survival and quality of care

Both stage at diagnosis and survival for breast cancer vary significantly by race/ethnicity, which raises concerns that delayed diagnosis and variations in treatment may contribute to poorer outcomes for vulnerable populations.
To achieve optimum quality of care for women with breast cancer, uniformity of care in accordance with consensus guidelines is needed. Recent reports highlights variations in provision of care for women with breast cancer and, differences in survival. Examination of differences in survival as a function of consultant caseload demonstrated poorer results amongst those surgeons treating less than 30 new cases of breast cancer per year. Experts recommend that patients with breast cancer be dealt with only by clinicians who see more than 30 new cases per year and who have a full range of treatment options available within a multidisciplinary setting.
The benefit associated with care provided by specialists may be due not only to surgery but to the use of additional therapies. Chemotherapy and hormone therapy prolong disease-free and overall survival for patients with breast cancer in the clinical-trial setting however strong variation in treatment was identified outside MDBCC which appeared to affect survival significantly. These findings reinforce the need for women with breast cancer to be treated by dedicated specialists working within a multidisciplinary team to provide a high standard of care.

Conclusion

It is now accepted that optimal treatment for patients with breast cancer requires a multidisciplinary approach, and that before any decision is taken on treatment, the patient should be seen by or discussed with the whole interdisciplinary team--surgeon, radiologist, pathologist, medical oncologist, radiation oncologist, and psychologist. Furthermore multidisciplinary breast clinics achieve a measure of uniformity and quality by working according to agreed protocols in order to improve survival and quality of life. If in MDBCC the breast cancer patients are seen before a decision on treatment by the multidisciplinary team and then managed by that team with major support from other health workers who include physiotherapists, social workers, psychotherapists, and alternative therapy nurses, then we will once again end up with a two tier system for the treatment of patients with breast cancer.

References

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