After opening a comprehensive breast center (CBC), one hospital achieved significant improvement in key measures of quality of care for women undergoing breast reconstruction, reports the November issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
Centralized breast cancer care at CBCs can lead to more timely breast reconstruction for women undergoing breast cancer surgery, suggests the study by ASPS Member Surgeon Albert H. Chao, MD, and colleagues of The Ohio State University, Columbus. They write, “Access to breast reconstruction at our institution improved significantly after our CBC opened, with significant increases in internal referral rates and immediate reconstruction rates.”
Transition to CBC Improves Processes of Care
The researchers assessed “process of care” outcomes related to breast reconstruction before and after their hospital transitioned to a CBC approach. Comprehensive breast centers seek to improve patient care and outcomes by assembling a group of highly specialized practitioners – oncologists, plastic and reconstructive surgeons, and other professionals – to provide coordinated breast cancer care. The study compared 614 women treated for breast cancer before the CBC transition and 750 women treated afterward.
Surgical oncologists (breast cancer surgeons) at the hospital saw about the same number of patients during both periods. However, after the CBC transition, patients were more likely to be referred to a plastic surgeon for breast reconstruction. The referral rate increased from about 27 percent to 46 percent.
Women treated in the CBC were also referred more promptly for breast reconstruction. “The time between surgical oncology consultation and plastic surgery consultation decreased from 10.5 days to 3.6 days,” Dr Chao and coauthors write. The percentage of patients who saw that breast cancer surgeon and plastic surgeon on the same day increased from 6.5 percent before the CBC was opened, to 50 percent afterward.
Improved Access to Timely Breast Reconstruction
For women who underwent mastectomy, the CBC approach increased the rate of immediate breast reconstruction: from about 40 percent to over 52 percent. In this group, the time between the plastic surgery visit and mastectomy/breast reconstruction decreased from about 42 days to 30 days.
Rates of important types of complications after breast reconstruction surgery were about the same before and after the CBC approach.
Because long-term follow-up is needed to assess the oncologic outcomes of breast cancer (survival, etc), studies of the quality of care provided at CBCs have focused on processes of care. The new experience suggests that large hospitals transitioning to the CBC approach may be able to offer breast reconstruction to more patients, with shorter times to plastic surgery referral.
Dr Chao and coauthors write, “A new diagnosis of breast cancer can be distressing for a patient, and every day that passes between the time the diagnosis is made and the time treatment is administered can increase a patient’s anxiety.” In the CBC approach, breast reconstruction consultations for new patients were scheduled in the afternoon, to enable more patients to have their surgical oncology and plastic surgery visits on the same day.
The researchers also note that the CBC approach was “financially sustainable” for their hospital, even after the investment in resources devoted to breast reconstruction. Dr Chao and colleagues conclude, “In breast reconstruction, a comprehensive breast center improves processes of care, and underscores the importance of plastic surgery involvement within these centers.”
Process Outcomes in Breast Reconstruction and the Impact of a Comprehensive Breast Center. Plastic & Reconstructive Surgery: November 2014 – Volume 134 – Issue 5 – p 675e–681e doi: 10.1097/PRS.0000000000000614