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New model of care for breast cancer streamlines patient pathway

Tuesday 14 November 2017

A new model of care to provide breast cancer patients with earlier access to breast reconstruction surgery is being trialled at Mater following the successful application for Queensland Health Futures project funding.

The new model, aligning with the Exceptional Every Time strategy, streamlines the process to enable breast reconstruction discussions to take place prior to a mastectomy, providing the patient with a defined pathway following their surgery and a reduction in appointments and waiting times.

Breast cancer is the most commonly diagnosed cancer in females and one of the top three most prevalent cancers in Queensland. The treatment for this patient group may include surgery, radiotherapy, chemotherapy, hormone therapy and other targeted therapies with women needing care from multiple specialists, health practitioners and their GP, highlighting a complex patient journey and many interactions with the health system across different timeframes and locations.

Mater currently receives more than 1200 referrals a year for public patients at different points through their breast cancer journey.  Many of these patients face long outpatient waitlists which are more pronounced for patients living outside South East Queensland.

Mater Director of General Surgery Dr Chris Pyke said that international best practice indicates patients should have a reconstruction discussion, including their suitability and options, before a mastectomy.

“This is not happening in Queensland due to a lack of access to plastics and oncoplastics specialists, particularly in regional and remote centres,” Dr Pyke said.

“At Mater we have oncoplastics specialist teams who have an opportunity to take their skills and help Queensland develop current local resources to reduce the access issues for reconstruction conversations.”

The solution developed by the Mater team has been to establish a state-wide virtual meeting group to include breast, oncoplastics and plastic surgeons and the referring doctor.  Utilising video conference, telehealth store and forward, and 3D imaging software, a case-conference type discussion can occur where the patient’s oncology history and clinical photography can be reviewed and considered by the referring specialist and clinical leaders in breast reconstruction.  Breast surgeons from anywhere in Queensland are able to refer a patient who has been diagnosed with breast cancer to the meeting group who will hold a weekly video conference with referring parties.

Following the discussion a recommendation can be returned to the specialist along with a PDF version of any required imaging allowing the local specialist to then have a discussion with the patient around the outcome, prior to their mastectomy. 

The benefits of the new model in managing breast reconstruction patient pathways, includes:

  • ensuring patients with diagnosed breast cancer undergo appropriate discussion and decision making and have a recommended treatment plan developed
  • appropriate referral onto the treatment team for individualised treatment
  • reduced psychological trauma associated with mastectomy
  • standardised management for the purpose of practice improvement
  • strengthening communication between patients, tertiary and primary care settings at critical decision making points
  • reduction in wait times for access to reconstruction discussion
  • reduction in travel costs for regional and rural patients and allowing appointments and treatment closer to home when appropriate
  • creation of  a professional network between referring specialists and GPs building access, links, educational opportunities and a state-wide approach to breast reconstruction.
  • cost savings from reduced appointments and travel
  • efficient and sustainable use of resources.             

Mater Health Service Manager (ENT/General Surgery/Breast & Endocrine) Amy Brennan said an internal pilot had already been undertaken at Mater and had shown the meeting avoided unnecessary appointments and travel for patients while supporting best practice options for local and remote patients. 

“There was a 30 per cent reduction in referrals to the plastics team as discussions could be delivered by the breast surgeon reducing demand on the plastics waitlist. This was also reflected in a reduction in wait times for patients,” Ms Brennan said.

“With the grant from Queensland Health Futures, we hope to implement and evaluate the full potential of the meeting over a 12 month period and show improvement in wait times and appointment capacity while also improving patient care, experience, quality and satisfaction across the cancer journey.”

The Queensland Health Futures funding grant for $195 000 will enable Mater to employ an administrative assistant to prepare and coordinate the weekly meetings, purchase a 3D camera and imaging program and increase medical and nursing support to deliver the program.  

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