Canadian Health Services Research Foundation

St. Joseph’s Health Care London: Consolidating services, improving care for breast cancer patients

When you put patients at the centre of the picture, good things start to happen.

That’s been the experience in London, Ontario, where breast cancer patients have traditionally had to move from site to site across the region for diagnosis and treatment. Breast care services exist at four sites throughout the city and each year there are some 37,600 visits in London (apart from those for chemotherapy and radiation). Each time a patient moves from one centre to the next, it causes disruption and adds to wait times – a cancer patient’s biggest concern, says Jane Stacey, the Coordinator, Rapid Access, Oncology at St. Joseph’s Health Care, London. "Because you bounce patients around so many times, it adds to the overall length of their journey."

Indeed, wait times for surgery once malignancy is diagnosed are almost twice as long in London as the Ontario average. The process of getting a diagnosis and moving to surgery can take three or four separate appointments, while surgery is performed across three different sites, each with its own support model. The result is that care is disjointed across the city. Worse, through the whole decision-making process, the patient gets lost. "They walk out the door and I just think we’re dropping them into a deep, dark hole," says Jane Stacey, Coordinator, Rapid Access, Oncology at St. Joseph’s Health Care, London. "No one connects from the patient perspective, about the patient’s journey."

The organization decided to do something to make things better. It conceived of a new model of care where all necessary services would be brought together in one location – a rapid access breast care centre that includes screening, diagnosis and surgery.

Turning a vision into reality

That model is now poised to become a reality, with implementation set to begin in September 2010. Chemotherapy and radiation will not be part of the site, but will continue to be provided through the London Regional Cancer Program. A multidisciplinary team will develop individualized treatment plans for each patient and a team of nurse navigators moving between imaging and surgery services will provide seamless support throughout a patient’s care journey. The centre will work with community partners as well, so that patients are aware of the wider support networks available to them. The result will be a centre of excellence in breast care services, with reduced wait times at all stages of care, as well as improvements in the quality of care.

"We're not looking at the next mammogram - we're looking at the entire care journey."

- Dr. Donald Taves, Co-Chief of Radiology

Clinic coordinator Suzie Almeida says she is not aware of a comparable centre in Canada with this type of setup. "We were able to take some bits and pieces of what we learned from the literature and talking to people," she says. "This is really about all patients having information and resources available to them. Patients can choose as much or as little as they need."

Seeing it from the patient's perspective

Keri Hanlon was diagnosed with breast cancer in January 2009 and underwent a lumpectomy, chemotherapy and radiation, and then a mastectomy. "Last year was the hardest thing I’ve ever had to deal with," says the 37-year-old mother of two young children. While the consolidated rapid access breast care centre was not available to her at that time, she believes that it will definitely benefit future patients. "If it was all in one place, you wouldn’t have to worry about keeping track of records, knowing where to go. It would make it a lot easier."

Consolidating, flourishing – and saving money

Right now, patients aren’t the only ones travelling throughout the city – surgeons and radiologists are expected to make the same journey. Under the new model, they won’t be spending much of their days in transit. And, if a surgeon wants to consult a radiologist, it will simply be a matter of stepping across the hall. "The consolidated program allows the opportunity for like-minded individuals to work under the same roof," says Dr. Donald Taves, Co-Chief of Radiology, St. Joseph’s and the London Health Sciences Centre. "The synergy is much more than one plus one equals two."

Dr. Taves predicts that the consolidated program will flourish, involving the full gamut of healthcare professionals. He is particularly proud that the program won’t incur any additional costs, and may even cost less. Cost savings will come from requiring fewer mammography machines throughout the system, more efficient use of human resources and the inclusion of a procedure room where smaller procedures like lumpectomies can be performed under local anesthesia. As well, increasing the proportion of women being screened for breast cancer will also deliver cost savings, as earlier diagnosis means treatment is less expensive – and more likely to succeed.

"We’ve been working toward this for the last 12 years," says Dr. Taves. "We’re not looking at the next mammogram – we’re looking at the entire care journey."