Study evaluates importance of timeliness of care in breast cancer diagnosis and treatment

While timely care can reduce stress among breast cancer patients about their condition, the drive for expediency should not compromise other factors important to care, such as safety, effectiveness, efficiency, and equity, according to new research findings published in the April issue of the Journal of the American College of Surgeons.

Patients who receive a breast cancer diagnosis - and one in eight women will receive one in their lifetimes - often immediately tell their clinician, "I want treatment as soon as possible," the authors say. This study is the first to ask the questions "how long is too long with regard to patient satisfaction?," and "how can that wait be reduced without compromising quality?"

The authors focused on measuring patient satisfaction at a breast cancer center that adheres to timeliness criteria published by professional organizations. They measured all components of timeliness, from the first breast cancer symptom or sign to operative treatment, while also surveying patient satisfaction as it relates to published timeliness goals. They found that more than 90 percent of these patients had their expectations met or exceeded with regard to dates of service from diagnostic evaluation to treatment.

"While most breast cancer patients expect treatment as soon as possible, patient education, informed consent, and a comprehensive diagnostic evaluation are also important, and these components all take time," according to Jeffrey Landercasper, MD, FACS, general surgeon, Gundersen Lutheran Health System, La Crosse, WI. "However, the goal of timely care is to complement, not compete, with the other factors important to quality of care. We recommend institutions perform a timeliness audit to identify the causes of delay, correlate timeliness with patient satisfaction, and compare their performance to published timeliness targets."

Researchers also found that timely care is facilitated by a team approach to interdisciplinary care, with all the subspecialists working together with established care pathways and self-imposed timeliness targets for access to care. Quick access to numerous consultants was aided by breast specialty nurses and medical assistants who made an effort to determine and comply with the patient's sense of urgency.

The authors' goal was to help breast care providers and their professional organizations understand and, if possible, reduce the source of delays, and to explore the relationship between timeliness and patient satisfaction.

Researchers, including a range of surgeons, radiologists, auditing staff and nurses, used the electronic medical records of all patients who received a diagnosis of breast cancer between January 2004 and September 2007 at a single breast center. Time intervals from an abnormal mammogram screening or breast symptom to diagnostic evaluation, to pathology reporting, and to surgical treatment were tabulated. A postal survey of patient satisfaction was also conducted for patients diagnosed between 2004 and 2006. Patients were asked if their expectations for timeliness in appointments for testing, consultations and treatment were met.

The median time interval in business days from abnormal mammogram screening to diagnostic evaluation and core needle biopsy was six days. The median time intervals from core needle biopsy (CNB) to CNB pathology report, and then subsequent surgical consultation and breast cancer operation, were one, three and seven days, respectively. Factors that prolonged time to treatment were breast MRI, systemic imaging, plastic surgery consultation, type of surgical procedure, and patient choice.

The response rate for the postal survey was 52 percent (n=458). Within the survey, 91 percent (n=234) of patients' expectations were met or exceeded when asked if they were able to schedule their appointment as soon as desired. When asked about the time from abnormal screening to diagnostic evaluation, 96 percent (n=233) of patients' expectations were met or exceeded. The survey also showed patients were satisfied regarding the time to diagnosis to an appointment with a surgeon and the time from that appointment to the operation itself, with 97 percent (n=237) and 95 percent (n=231), respectively, reporting that their expectations were met or exceeded.