The Importance of Multidisciplinary Approach and Quality Control in a Breast Centre

By Dr Lorenza Marotti, Executive Director of Eusoma

 

Breast Centre is the place where breast cancer is diagnosed and treated; it has to provide all services necessary from genetics to prevention, to the treatment of the primary tumour, to care of advanced disease, to palliation and survivorship and psycho-social support.

Eusoma since 2000 has published a milestone document on the requirements of a specialist Breast Centre, which has been pivotal for the setup of Breast Centre not only in Europe but also overseas and has been taken into consideration by national Authorities to define the organization of breast cancer management in their countries. Despite this, as highlighted in the EBCC-10 Manifesto (EJC 72 (2017) 244-250), still too many European Countries have not deliberated on the management of Breast Cancer, missing the 2016 deadline for all patients in European Countries to access specialist multidisciplinary breast cancer units or centre.

Requirements are important referring tools and, as such, need to be regularly up-dated.

In this view, Eusoma, with the endorsement of the European Cancer Care Organisation as part of its Essential Requirements for Quality Cancer Care (ERQCC) programme, has finalised the updating of the paper “The requirements of a specialist Breast Centre” (EJC2013;49,3579-3587), with the contribution of European experts and representative of the European Cancer Organisation's member discipline societies involved in the management of Breast Cancer Care.

This document will contain the updating of the existing Eusoma requirements taking into consideration changes in organization and care in the past five years and will also include sections on epidemiology, challenges in breast cancer and quality and audit processes.

Multidisciplinary approach, based on dedicated health professionals and quality control are two essential aspects of a specialist breast Centre, which has to offer harmonised quality care, regardless in which European country a person lives.

Multidisciplinary approach is based on the concept that not a single specialist but a group of specialised and dedicated experts will take shared decision on the diagnosis and care to be delivered to each patient.

Therefore, each Breast Centre must hold weekly multidisciplinary case management meeting to discuss diagnostic preoperative and postoperative cases and any other issue related to breast cancer patients, which need multidisciplinary discussion.

As highlighted in literature, this approach results into a great impact on patient survival. A 2012 UK observational cohort study (Kesson EM et al Br. Med J 2012; 344:e2178), evaluating the effects of multidisciplinary approach on nearly 14.000 women, showed that this approach was associated with a 18% lower mortality at 5 years.

Quality control is an essential tool to monitor the activity of the Breast Centre, the compliance with the adopted recommendations and protocols, the performance with regard to Quality Indicators.

It is necessary that each Breast Centre collects its data in a database and has within the team a data manager, i.e. a person qualified and trained to be responsible of the breast Centre data.

The data manager works under the supervision of the breast Centre clinical lead, organises audit meeting, monitors the trend of the Quality Indicators, keeps the team informed on that and takes part in the, at least yearly audit meeting, where all the team together discusses on the breast centres performance, on the need for any changes, improvements. Again, with a multidisciplinary approach, the team identifies the necessary corrective actions, which might be not only clinical but also organizational or structural and therefore needs the involvement of the hospital management.

Quality control is very important not only for the single Breast Centre but also for the entire scientific community, because the benchmarking of the results of the different centres represent a helpful resource in the up-dating of national and international guidelines, in identifying new quality indicators or amendments of the existing ones.

Collecting data is essential for the scientific research at the breast centre, to allow to develop specific project and to publish local experience or to join national and international project.

There is evidence on the benefit of external audit, i.e. certification or accreditation, to better performance and outcomes, and this is true also for a breast centre.

Therefore, it is advised that a Breast Centre undergo a voluntary certification/accreditation process based on the offer at national or international level such as for example German Cancer Society and German Senology Society, National Accreditation program for Breast Centre (NAPBC) run by the American College of Surgeons, Breast Centre Certification, accredited scheme based on the Eusoma requirements and Quality Indicators.

The contribution of policymakers and politicians to make sure that all women in Europe are treated in specialist breast centres is fundamental. Only joint forces from health professionals, patients’ advocates, policymakers and politicians can ensure that breast cancer patients have access to specialist breast centres in any European countries.

Article published in Government Gazette Spring 2019 edition.