Are Women With Breast Cancer Seeing The Most Experienced Surgeons?

Up for a quiz? Great. Assume that you or your spouse were newly diagnosed with breast cancer and needed to see a breast cancer surgeon. How would go about finding a breast cancer surgeon to help treat your cancer? Remember, your treatment outcome is riding upon making the right choice.

In choosing a breast cancer surgeon would you:

1. Select from list of surgeons available through your health plan.
2. Go to a surgeon referred by another doctor.
3. Choose the surgeon based upon their reputation.
4. Go to a surgeon recommended by a family or friend.
5. Go to a surgeon based upon the hospital where they worked.
6. Go to a surgeon that was near my home.

A recent study conducted by the University of Michigan Comprehensive Cancer Center put these very questions to 1,844 female breast cancer patients in Detroit and Los Angeles.

Here’s what the study found*:

• 15% selected their surgeon from the health plan list
• 63% selected their surgeon based upon referral from another doctor
• 25% selected their surgeon based upon their reputation
• 15% selected their surgeon based upon the hospital where they worked
• 13% selected their surgeon based upon the recommendation of family or friends
• 9% selected their surgeon based upon proximity to home

* Respondents were free to cite more than one answer.

So which of these "selection methods" do you think gave breast cancer patients in the study the best odds of achieving a good outcome? According to the research, the best treatment outcomes for complex cases like cancer are associated with physicians and hospitals that treat high volumes of specific types of cancers e.g., breast cancer surgeon that perform a high volume of breast cancer surgeries.

The patients in the study most likely to experience the best outcomes were those who selected their surgeon based upon their "reputation." Why? As it turned out, these patients were more likely to get treatment from surgeons that did a high volume of breast cancer surgeries at specialized, high volume National Cancer Center-accredited hospitals. Study participants who selected their surgeon based upon reputation were also more likely to have seen two or more surgeons before surgery, i.e., more likely to seek a second opinion.

Interestingly, study participants who selected a surgeon based upon the referral from another doctor were less likely to end up being treated by a surgeon that did a high volume of breast cancer surgeries.

What’s the Bottom Line?

If you need a specialist for breast cancer or any cancer treatment for that matter, do your homework. Don’t settle for taking your doctor’s recommendation. The patients that proactively sought out information concerning the reputation of surgeon, including getting second opinions, were more likely to be treated b high volume surgeons at highly specialized cancer care centers.

For more on this study go to:

http://www.med.umich.edu/opm/newspage/2007/breastcancersurgeon.htm

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More Compelling Evidence That Patient Outcomes Are Better At Specialized High Volume Cancer Hospitals – Lung Cancer, A Case In Point

Preliminary findings from a study presented at last week’s meeting International Association for the Study of Lung Cancer in Seoul, Korea demonstrates why it so important for cancer patients or their spouses to carefully choose the right physician and the right hospital for their treatment.

The study examined the post-operative mortality for Stage III A/B non-small-cell lung cancer (NSCLC) patients undergoing complex “trimodality therapy.” This is a complex treatment where patients undergo concurrent chemotherapy and radiation followed by surgery (pneumonectomy). According to Aaron Allen, M.D., the study author, the mortality rate for patients at a nationally recognized U.S. cancer center was 4% at 30 days post surgery compared to a 30-day mortality rate of 26% from an earlier multi-hospital study

Allen, who is with the Department of Radiation Oncology at the Dana-Farber Cancer Institute, said “his suggests that the success of trimodality therapy was dependent upon two factors, the experience of the clinical center and the location of the lesion.”

Antoinette Wozniak, M.D., of the Hudson-Webber Cancer Research Center at Wayne State in Detroit, commented on Dr. Allen’s findings saying she believes that "many of these (advanced cancer) treatments work well in the hands of experienced operators," but may not translate well into the low-volume, community-based cancer care hospitals.

The study involved a retrospective analysis of the records and survival rates of 74 Stage III A/B NSCLC patients that underwent trimodality therapy between 1994 and 2005. The median age of patients was 58. Fifty-nine percent of cases were squamous cell carcinoma and 41% were adenocarcinoma. All surgeries were conducted at Brigham and Women's Hospital, which is affiliated with the Dana-Farber.

Lung cancer is the leading cause of cancer deaths. In the United States, 213,380 new cases and 160,390 deaths from the disease are expected this year.

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