The project set up in the Netherlands has delivered exactly what it promised, namely measurably improved outcomes for breast cancer patients. Many countries have National Cancer Plans, few of which have delivered their full potential. The Netherlands was one of the first to set up cancer networks in 1980, backed by legislation that ensured cancer patients the right to a specialist oncologist's opinion. Many European countries still do not offer such a right.
Now the Netherlands leads oncology treatment once more. Dr Emil Rutgers, from the Netherlands Cancer Institute (which first showed the potential of gene signatures in prognosticating in breast cancer), described a very low-tech approach to accelerated management of patients suspected of having breast cancer. They set up and achieved targets for faster diagnosis (2 weeks), reduced time to operation (3 weeks), and reduction of unnecessary operations (10- 35%).
All patients visiting a breast cancer clinic were evaluated pre-op by a multidisciplinary team, and yields of cells obtained from the breast lump were improved by only allowing trained professionals to do the breast punctures and by increasing the use of image guided biopsies. 22 teams around Holland took part, and 19 achieved a waiting time of one week. Many others achieved 2 to 3 weeks in other countries, but few got the subsequent time to diagnosis down to one week (18 hospital breakthrough teams did it in this study). And magnificently, all 22 teams had their patients in the operating room for surgical treatment within 3 weeks, 10 teams doing this within 2 weeks.
Surely if the Netherlands can do this, every other European country must strive harder to reproduce this exemplary performance. Ingrid Kössler, President of Europa Donna comments, "One of the worst experiences a woman can suffer is the delay and uncertainty which follows suspicion of a cancer in the breast. In some countries the time from the family doctor or patient herself finding a lump to first surgical treatment can be two months. Surely this is unnecessary. We congratulate the Dutch breakthrough teams and urge healthcare professionals and politicians to take note of what is possible and we advise breast cancer patients not to accept lower standards of care."
Notes: Europa Donna, The European Breast Cancer Coalition was founded in 1994. It aims to raise awareness of breast cancer and improve breast services across Europe through advocacy and education. This non-profit organisation represents the concerns of European women to local and national authorities and also to governments and institutions of the European Union. Each country has its own national Europa Donna group called a forum. Currently there are 39 member countries. Europa Donna is a member of Cancer World. www.europadonna.org
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PP5 Epidemiology, prevention, f.up, management and care
Measurable improvement of breast cancer care in the Netherlands by breakthrough project
E.J.T. Rutgers1, J. Benraadt2, B. Fröhleke2, M. van Langen2, M. Coppens2, J. Salomé2, A.E. van Leeuwen-Stok2, F. Seesing3, Y. Koense3 1
Netherlands Cancer Institute, Oncological Surgery, Amsterdam, The Netherlands 2The Dutch Association of Comprehensive Cancer Centres (ACCC), Utrecht, The Netherlands 3The Dutch Institute for Healthcare Improvement (CBO), Utrecht, The Netherlands.
Objective: To improve breast cancer care in breast cancer units in the Netherlands through structured realisation of best practices as described in a clinical practice guideline.
Methods: Four goals were identified through analysis of data and reports, and interviews with practitioners: faster triple diagnosis (= 2 weeks), reduction of waiting time for operation (= 3 weeks), 10% - 35% reduction of operation burden by reducing unnecessary operations and more frequent preoperative multidisciplinary consultations.
All patients visiting a breast outpatients' clinic were to be evaluated preoperative by a multidisciplinary team consisting of a surgeon, a radiologist, a pathologist and a breast cancer nurse. The yield of punctates was to be improved by limiting the practice of the procedure to dedicated professionals, and biopsies directed by imaging (ultrasound or stereotaxis). This should lead to more clear-cut diagnoses, less diagnostic operations, less re-operations and less control visits.
A database was developed for the collection of data and the automatic generation of indicators. Throughout the project, breakthrough-managers and health professionals co-operated intensely to develop hands-on material for teams to achieve practical improvements.
Results: Twenty-two teams participated for one year in this breakthrough project. Nineteen out of the twenty-two teams achieved an average waiting time of one week for patients with breast symptoms to the outpatients' clinic. Diagnosis was established within one week on average in 18 hospitals. All hospitals achieved an average waiting time of three weeks for women with diagnosed breast cancer to undergo operation 10 teams achieved two weeks. Seventeen teams had a clear-cut (pre-operative) diagnosis in 95% of cases by the end of the project. At least 50% of patients were discussed in a multidisciplinary setting before operation in 13 teams, while this result was achieved by 4 teams only at the start of the project. An additional goal was identified in the form of pre-operative consultation by a breast cancer nurse. In 19 teams at least 60% of the patients were seen pre-operative by a breast cancer nurse. Team-building showed to be a very important non-measurable positive result of this Breakthrough project.
Conclusions: Breast cancer care has been measurably improved by structured implementation of best practices.
Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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