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Most Oncologic Surgeons Do Not Adhere to Cancer Care Standards

Posted Jan 07 2010 12:00am

I am a staunch believer in the use of multidisciplinary teams (MDT) in the treatment of complex diseases, notably cancer. Along these same lines, I also believe that anyone with a newly diagnosed cancer should rush themselves to the nearest specialized cancer hospital where integrated diagnosis and treatment by MDTs tends to be the standard of care. I provided details about the basis for this recommendation in a previous note (see: Some Tips for Selecting a "Good" Doctor and a "Good" Hospital):

If I were personally seeking care for cancer, I would get myself to a specialized cancer hospital or clinic, even if it involved some travel. In my personal opinion, there are four criteria to keep in mind when seeking the best cancer treatment: (1) physicians and staff at the facility should treat many patients per week with the same or similar diagnosis as yours; (2) the physicians should pride themselves on being up-to-date on the latest research and treatment of your disease as well as available clinical trials; (3) there should be little or no direct connection between the treatment being offered to you and the salary of the treating physicians, and (4) your treatment plan should be developed by a multi-specialty panel of physicians working in the facility, resulting in a more nuanced and balanced approach.

Now comes additional evidence about the wisdom of this advice and some insights into practice standards among oncologic breast surgeons (see: Few Breast Cancer Surgeons Follow Quality of Care Standards, Study Finds)

Most breast cancer surgeons' practices do not follow standards associated with the best quality of care....These standards include consulting with other specialists and providing resources and education to help patients make treatment decisions....Researchers surveyed 318 surgeons who treated breast cancer patients in the Detroit and Los Angeles metropolitan areas. 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
  • Connecting patients with peers, for example through support groups
About one-quarter to one-third of surgeons reported they had routinely discussed patients' treatment plans with medical or radiation oncologists. Only 13 percent routinely consulted with a plastic surgeon. About one-third of surgeons said their patients typically participate in patient decision support activities, such as viewing a video or Web-based materials or attending peer support programs.

I personally find the results of this study shocking but believable. I have personal knowledge of one cancer patient who asked her surgeon about possible chemotherapy following the surgery that he was about to perform. He replied that she this should not be a matter of concern for her and that he would make a referral to the oncologist "down the hall" post-surgery. As soon as any cancer is diagnosed, it's critical to develop a long-term multi-disciplinary care plan and most certainly attend to the patient's psychological stress during all of the care episodes. In the case of cancer care by private practitioners, the care process is often fragmented and insufficiently integrated. One symptom of such fragmentation is insufficient attention to the key tasks in the bulleted list above.

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