BC Clinics Fast-Track Breast Cancer Diagnosis
Vancouver, July 3, 2009 — Women across the Lower Mainland are now able to visit one of four rapid- access breast cancer diagnosis pilot clinics to quickly catch potential cases of breast cancer, thanks to a $5-million investment from the Province’s Lower Mainland Innovation and Integration Fund (LMIIF), announced Health Services Minister Kevin Falcon today. “Every one of us is touched in some way by breast cancer and we now know that catching it quickly dramatically improves health outcomes,” said Falcon. “By investing in innovative new models of care – like these rapid access clinics – we are building on our comprehensive network of cancer services, and further enhancing BC’s reputation as a leader in cancer care.”
Falcon made the announcement at the rapid access breast clinic at Providence Health Care’s Mount Saint Joseph Hospital (MSJ), which opened to patients in May. The clinic is based on the European best-practice model, serving as a single point of intake where diagnostic testing for breast cancer is co-ordinated and organized.
The other rapid-access breast cancer diagnosis clinics are operating at Surrey Memorial Hospital and Royal Columbian Hospital in Fraser Health, with plans to extend to a fourth clinic at BC Women’s Hospital & Health Centre in conjunction with the BC Cancer Agency, both agencies of the Provincial Health Services Authority (PHSA), and X-Ray 505, an accredited diagnostic imaging facility, in early August.
So far, the results of MSJ’s clinic are extremely promising. They have set a target of providing all patients with a diagnosis within 21 calendar days (the European standard), and have been able to meet that target 98 per cent of the time. In fact, the average wait time has been reduced from about 45 days down to just six.
“Providence Health Care is very proud to be the first to pilot this new best practice model and to expand the services of our well established Breast Care Program at Mount Saint Joseph Hospital,” said Dianne Doyle, Providence Health Care President and CEO. “By offering patients their screening, exams, diagnoses and surgery in an integrated and timely manner all under one roof, we’re treating patients how they want to be treated.”
The goal of each of the clinics is to reduce the wait time from referral to diagnosis, and increase patient access to care by streamlining the diagnosis process. Patients at risk of breast cancer currently require many separately scheduled visits to different health care providers at physically different settings at each stage of the diagnostic and treatment pathway, often creating unnecessary gaps and delays in care. All of the clinics are working towards implementing the European Society of Mastology (EUSOMA) standards of best practice. “This innovative approach is already paying dividends,” said Dr. Urve Kuusk, medical director of the Mount Saint Joseph clinic and breast surgeon. “With our streamlined process, all tests and exams are done on site, with a core team of multidisciplinary staff working together to carefully follow the patient. Everyone wins – the patients don’t fall through the cracks, we eliminate duplication of services and multiple visits and we can ensure all aspects of the patient’s diagnostic journey are addressed.”
“Waiting is one of the worst parts of hearing that you may have breast cancer,” said Lynda Cho, a breast cancer patient at the clinic. “At Mount Saint Joseph’s rapid access clinic, by shortening the time to diagnosis, much of that stress was alleviated during what was a very nerve-wracking experience. And, as a busy mom of two kids, it was especially convenient having everything done in one place, from my mammogram to receiving my diagnosis to surgery, and very comforting to deal with only one health-care team.”
In Fraser Health, Royal Columbian and Surrey Memorial Hospitals are working together on their rapid access breast clinics. Their project has received approximately $1.4 million in LMIIF funding, and is working to decrease wait times for diagnostic procedures, and increase the imaging capacity. Their clinics were up and running in April 2009 and they have so far performed nearly 600 diagnostic procedures.
“Fraser Health is actively working at developing an integrated breast health program, and these clinics are a critical component,” said Marc Pelletier, VP Clinical Support and Strategic Planning, Fraser Health. “We are also hoping to adapt the learnings gained from these clinics to the new Surrey Outpatient Hospital, which will be opening in 2011.”
The BC Cancer Agency rapid access breast clinic at BC Women’s Hospital and Health Centre will integrate three busy and experienced breast imaging centres in Vancouver with central nurse navigation, booking, and access to GP oncologists.
“As the provincial body for co-ordinating cancer care, the BC Cancer Agency is working with BC Women’s and X-Ray 505 to offer this rapid-access breast cancer diagnosis clinic that is scheduled to open in early August,” said Dr. Stephen Chia, medical oncologist and chair of the BC Cancer Agency Breast Tumour Group. “As part of our clinic, we are also offering access within four working days to breast medical oncologists for locally advanced breast cancer cases for timely investigation and initiation of pre-operative chemotherapy, if necessary.”
Assuming the breast cancer incidence rate remains constant, 7.4 per cent or 140,600 B.C. women receiving a breast screening exam in 2010 will have a suspicion of breast cancer. Multiple diagnostic tests are required in order to rule out or confirm a cancer diagnosis. According to the Canadian Cancer Society’s 2009 Canadian Cancer Statistics report, B.C. women have the lowest overall mortality rate for all cancers in Canada. The BC Cancer Agency provides a comprehensive screening mammography program, free for all B.C. women aged 40 to 79.
Mount Saint Joseph Rapid-Access Breast Diagnosis Clinic
B.C.’s first comprehensive one-stop rapid-access breast cancer diagnostic clinic at Mount Saint Joseph Hospital (MSJ) is receiving $1.25 million in pilot funding through the Lower Mainland Innovation and Integration Fund (LMIIF) to streamline diagnostic services.
The Rapid Access Breast Clinic is based on the European best-practice model, serving as a single point of intake where diagnostic testing for breast cancer is co-ordinated and organized. Its goal is to provide a diagnosis to patients within 21 calendar days, following the European standard target. The clinic’s multidisciplinary team is composed of a clinical director, breast surgeons, breast radiologists, a breast pathologist, nurse navigator, nurse practitioner and general practitioner. For all patients, a “triple assessment” is conducted, starting with a diagnostic mammogram and/or diagnostic ultrasound, followed by a physical examination by a breast specialist, and then an ultrasound-guided or stereotactic core biopsy.
If a patient receives a positive diagnosis, the clinic prepares a co-ordinated care plan, organizing direct referrals for surgery and other breast services (radiation and chemotherapy), avoiding the need for the patient to go back to their family physician for the referral. The clinic also co-ordinates further diagnostics (such as breast MRI), surgical bookings, medical oncology consults, radiation oncology consults, and BC Cancer Agency consults and provides direct referrals to MSJ’s breast reconstruction program, providing immediate or post-surgical breast reconstruction by a plastic surgeon.
Patients awaiting diagnosis appreciate the unique role played by the nurse navigator, who helps patients navigate the system, and acts as their one point of contact for questions and emotional support. The MSJ nurse navigator is a registered nurse and a 14-year breast cancer survivor who is able to relate and connect with patients very well.
About the MSJ Rapid Access Breast Clinic:
• Total patients treated since opening - 244
• Total patients seen within target (21 days to diagnosis) - 239 or 98 per cent
• Average time from referral to diagnosis - 6 days
• Average number of patients seen per day - 6 (will expand to 20 patients/day as clinic becomes more established)
• Total positive diagnoses - 7
• Total diagnostic tests performed - 385
• Diagnostic mammography - 171
• Breast ultrasound - 170
• Core biopsies - 25
• Fine needle aspirations - 19
• Patients are accepted into the clinic either a) as a result of an abnormal screen found through MSJ’s Screening Mammography Program OR b) upon referral by a Vancouver-based general practitioner, where the patient has not had previous diagnostic work-ups at any other diagnostic centre within the last two calendar years.
The LMIIF funding will allow the MSJ Clinic to diagnose up to 3,000 patients annually, once fully operational.
About the Mount Saint Joseph Breast Program
The MSJ Rapid Access Breast Clinic is part of the Mount Saint Joseph Hospital Breast Program, a comprehensive program that offers services from screening through surgery. Home to one of the province’s screening mammography sites, the program offers a seamless transition to diagnostics, including the latest technology in the form of a digital mammography machine with tomosynthesis capabilities. If a positive diagnosis is suspected or confirmed, there is a transition to three dedicated breast cancer surgeons. MSJ is the largest mastectomy centre in the Lower Mainland, performing more than 400 mastectomies a year. Breast reconstruction is also co-ordinated and offered at MSJ through skilled plastic surgeons. About Providence Health Care: Providence Health Care is one of Canada’s largest faith-based health-care organizations, operating 14 health-care facilities in Greater Vancouver. Guided by the principle “How you want to be treated,” PHC’s 1,000 physicians and 6,000 staff deliver compassionate care to patients and residents in British Columbia. Providence’s programs and services span the complete continuum of care and serve people throughout B.C. As a renowned academic health science leader, PHC operates one of two teaching hospitals in the province, performs cutting-edge research in more than 30 clinical specialties, and focuses its services on six “populations of emphasis”: cardio-pulmonary risks and illnesses, HIV/AIDS, mental health, renal risks and illness, specialized needs in aging and urban health. Visit www.providencehealthcare.org to learn more.
The Lower Mainland Innovation and Integration Fund
The Lower Mainland Innovation and Integration Fund was announced as a key health initiative of the 2008 provincial throne speech. It provides Vancouver Coastal Health and Fraser Health with $75 million to move beyond block funding toward a new provincewide, patient-centred funding model. The new model ties funding to performance and increased service levels in specific areas, such as addressing surgical waitlists. The model also rewards integration, standardization and consolidation.
The fund is encouraging process improvements that will focus on activity levels by using existing people and resources more effectively to improve outcomes. The two health authorities are working toward greater co-operation and to further integrate programs to operate more effectively. The regional authorities also work closely with agencies of the Provincial Health Services Authority, such as the BC Cancer Agency, which helps ensure access to a co-ordinated network of high-quality specialized health care services.
Fraser Health and Vancouver Coastal Health received $50 million for use in 2008/09 to fund proposals from within the two health authorities, with the remaining $25 million available for access in 2009/10.
The fund is governed by a committee chaired by the VCHA board chair, and supported by the CEOs of VCHA and FHA, a senior physician, and a Ministry of Health Services representative. The committee is accountable for the stewardship of the fund and is responsible for establishing criteria and approval processes, reviewing and approving applications and reporting on the disposition of funds. As of spring 2009, the entire $75-million fund has been allocated towards more than 25 pilot projects that will provide greater support and increase access to health services in the Lower Mainland. As British Columbia’s two largest regional health authorities, Vancouver Coastal Health and Fraser Health provide community, hospital and residential care services to more than 60 per cent of the province’s population, as well as many specialized services to the entire province.
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