Teamwork saves breast cancer patients
SURVIVAL rates for breast cancer patients improve dramatically as a result of improved teamwork between surgeons, cancer specialists and nurses, a major new study has shown.
A change in approach, that has seen health staff make a concerted effort to work together, has resulted in survival increasing by 18 per cent when death rates were compared with lone doctors taking decisions about a patient’s care.
The study, in NHS Greater Glasgow and Clyde, looked at 13,722 women who had suffered from breast cancer since 1990 and offers clear evidence the new approach is working.
In the early 1990s, breast cancer sufferers tended to be under the control of just one physician, but doctors began to suspect that getting more experts involved in the treatment of each patient would improve survival rates. In 1995, a new treatment model was pioneered in Glasgow that saw each patient treated by multidisciplinary teams.
The model – believed to be the first of its kind in the UK – saw the establishment of teams led by a specialist surgeon, who was performing at least 50 breast cancer operations per year. The rest of the team would comprise cancer surgeons, pathologists, oncologists, radiologists and specialist nurses.
The teams used evidence-based guidelines, audited their performance and met regularly to discuss patient treatment. The approach has since been rolled out across Scotland.
Analysis of the outcome of the treatment given to the women before and after the introduction of multi-disciplinary teams revealed that the new approach made a huge improvement.
The study found that breast cancer deaths were 18 per cent lower for the five years after the start of their treatment. That margin of improvement was greater than the improvement experienced more generally elsewhere as a result of the development of better drugs and better surgical expertise.
The study also compared breast cancer survival in the Greater Glasgow Health Board area with the rest of the west of Scotland.
Survival was poorer in Glasgow - which had the unenviable reputation as the “cancer capital of Europe” - in the early 1990s but after multi-disciplinary teams were introduced, survival was nearly 20 per cent higher in Glasgow compared with other areas.
The study was led by Project Manager Eileen Kesson at the West of Scotland Cancer Surveillance Unit.
Kesson said: “Multidisciplinary teams were introduced in Greater Glasgow Health Board in the mid-1990s several years before the rest of the UK. They marked a new development in the delivery of cancer services but until now there has not been any strong evidence that they made any difference to patients’ survival.”
Mike McKirdy, a consultant surgeon at Paisley’s Royal Alexandria Hospital, is one of the doctors who has been involved in the project.
He said: “You have a group of people considering each case and making sure every aspect of care is being thought of. That’s instead of the previous way we worked in surgery when I was a junior, which was a very individual practice, whereby there might be someone who was very good, but there might be other people who are average – that’s the nature of all human existence.
“By working as a team you improve standards. The study has looked at a changing mortality for breast cancer over quite a long period of time. What has been seen is an improvement in Glasgow breast cancer patients over time as multi-disciplinary team work was introduced.”
A co-author of the study was Scotland’s Chief Medical Officer, Sir Harry Burns, formerly Director of Public Health in Glasgow and active in setting up multi-disciplinary teams.
Burns said: “We looked at the way the surgeon with the best survival rate in Glasgow worked in a team with his colleagues and modelled care for the whole health board on his approach.
“We are pleased the findings confirm our belief this is the best way to deliver breast cancer care and I’m pleased to report that this is the way breast cancer care is now delivered in Scotland and other parts of the UK.”
Breast cancer is the most common cancer in women in the UK. New cases have increased by 10 per cent in the past decade with 4,400 women diagnosed in Scotland in 2009. The lifetime risk of breast cancer is about one in 10.
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