Few Breast Cancer Surgeons Follow Quality of Care Standards

A new study claims that a majority of breast cancer surgeons' practices do not follow standards associated with the best quality of care, including consulting with other specialists and providing resources and education to help patients make treatment decisions.

Researchers at the University of Michigan (U-M; Ann Arbor, USA) surveyed 318 surgeons who treated breast cancer patients in the Detroit (MI, USA) and Los Angeles (CA, USA) metropolitan areas. The surgeons were asked about the processes and services available in their practice, including consulting with medical oncologists, radiation oncologists, and plastic surgeons; collecting or reviewing biopsy specimens or mammograms; offering patient education videos or presentations, and connecting patients with peers, for example through support groups. The measures were developed by the researchers based on accepted standards in other areas of chronic care.

The researchers found that only one-quarter to one-third of surgeons reported they had routinely discussed patients' treatment plans with medical or radiation oncologists; only 13% routinely consulted with a plastic surgeon. About one-third of surgeons said their patients typically participate in patient decision-support activities, such as viewing informational video or Web-based materials, or attending peer support programs. Surgeons who treated mostly breast cancer patients were more likely to report these services, compared to surgeons who saw fewer breast cancer patients. The study was published in the January 2010 issue of Medical Care.

"Despite the mantra for multidisciplinary decision-making and care intake for patients, surgeons in the community are reporting relatively little of that in their practices,” said lead author professor of internal medicine Steven Katz, M.D., M.P.H. "Either doctors are not convinced these elements matter, or there are logistical constraints in terms of building these standards into their practices. What the implications are for patients is unknown. These results suggest patients might find a more integrated practice among surgeons with higher volume.”

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