Breast Cancer: Model of Care
Written by Jan Hallam
Friday, 28 April 2017
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More than 40 years ago, the First Lady of the United States Betty Ford announced to the world that she had breast cancer and had undergone a mastectomy. It was a defining moment in the transformation of a taboo disease into a cause célèbre that has seen the likes of Nancy Reagan, Angelina Jolie, Kylie Minogue, Olivia Newton-John and a host of other high-profile women fight for more money for breast cancer research.

201705-Breast-Cancer-Awareness-lady-in-pinkThe result is a marketer’s dream – pink means breast cancer awareness, October is Breast Cancer Month, and cash rolls into fundraising organisations at an ever-increasing rate. In farewelling its celebrity patron Sarah Murdoch, wife of media mogul Lachlan, in 2015, the chair of the National Breast Cancer Foundation Elaine Henry said that Sarah had been “instrumental in raising the organisation’s profile and funding. During her tenure fundraising has increased from under $1 million per year to more than $27 million in 2014.”

For the clinicians and researchers on the ground such as Prof Christobel Saunders and a host of others in WA, this activism has helped improve knowledge and treatment of breast cancer which has given patients better choices and outcomes. It is a gift not to be wasted.

Teamwork the key

“This awareness has empowered women to seek better treatment and ensures that we are able to deliver. As a result we have been at the forefront of things like multidisciplinary and specialist coordinated care as well as close auditing of what we do,” she said.

Research by former WA GP Dr Jon Emery and E/Prof D’Arcy Holman into the attitude of rural patients to cancer highlights just how successful the breast aware campaign has been.

“It shows that people with prostate, colorectal and lung cancer tend to present late, whereas breast cancer tends to present early because people know it improves their treatment outcomes,” Christobel said.

“That awareness has also been good for research funding. It always causes argument but breast cancer has undoubtedly the largest portion of the research pie. But that’s good for all cancers. Some of the research is generic. We understand more about immunotherapy of cancers, the biology of cancers because of breast cancer research. We also understand the importance of psycho-social support. Breast cancer research has led the way which has translated into other conditions.”

Trials and translation

Christobel said WA hosted a broad range of research programs in cancer and breast cancer, some led the way on the national front. Projects such as the ROLLIS trial which will change the way breast imaging and surgery is conducted.

“Seeing local trials leading to a change of practice is an exciting thing, but research takes a long time.”

Another exciting area of the future is health outcomes research and Australia has the potential to be a world leader.

“We are hoping to establish a study of value-based health care, which is essentially measuring the outcomes of our care using both conventional outcomes and also patient-reported outcomes. We will be looking at how we deliver services that achieve value for the patient and value for the system.”

“It is a concept that came out of Harvard Business School which led to the establishment of the International Consortium of Health Outcome Measurements (ICHOM). I was fortunate to be the chair of the international working group on breast cancer which developed a whole suite of standards.”

“It’s rethinking how we look at outcomes to very much include what the patient wants. For example what does a man with prostate cancer want? He wants to survive, he doesn’t want the cancer to come back but he doesn’t want to be incontinent nor lose sexual function and he doesn’t want to lose his job.”

Ask the patient

“We have to ask the patient what is important to them and ask if we are achieving that in our health system? We really don’t know because we don’t measure that.”

“A lot of big cancer institutions around the world have taken this up and are now asking their patients what they want. It’s hard to do initially but eventually it leads to better value care because you’re not doing things that are ineffective or that are not in the patient’s best interest. There is growing interest in WA for this idea.”

In the Doctors Drum write-up on p26, the forum explored the inevitably of cultural change brought on by the growth of technology and the increasing demand on the health system. It was put to the meeting that if the profession did not lead the charge, the tech companies and bureaucrats would.

Having clinicians take charge of this value-based health care could be a good start. For while IT is important, determining what information was to be put into those systems and what to get out of them was crucial. For if done well, Christobel said, data input became feedback from clinician and patients, which was in turn embedded research results and from there it was clear to see what activity was going well and what needed improvement.

The next step is not surprising.

“In the US and Holland, they are exploring how to fund good value health care. How they measure that value is the next thing to solve.”