shutterstock_62520019Opening a comprehensive breast center (CBC) can help improve quality of care and access to care for women undergoing breast reconstruction, according to a case study at Ohio State University, Columbus.

CBCs assemble a group of oncologists, plastic and reconstructive surgeons, and other professionals—to provide coordinated breast cancer care.

The new experience suggests that large hospitals transitioning to the CBC approach may be able to offer breast reconstruction to more patients, with shorter times to plastic surgery referral.

The study, which appear in the November issue of Plastic and Reconstructive Surgery®, was conducted by Albert H. Chao, MD, and colleagues at Ohio State University, Columbus.

“Access to breast reconstruction at our institution improved significantly after our CBC opened, with significant increases in internal referral rates and immediate reconstruction rates,” Chao reports.

The study compared 614 women treated for breast cancer before the CBC transition and 750 women treated afterward.

Comprehensive breast centers assemble a group of oncologists, plastic and reconstructive surgeons, and other professionals—to provide coordinated breast cancer care.

Surgical oncologists saw about the same number of patients during both periods. However, after the CBC transition, patients were more likely to be referred to a plastic surgeon for breast reconstruction. The referral rate increased from about 27% to 46%.

Women treated in the CBC were also referred more promptly for breast reconstruction. “The time between surgical oncology consultation and plastic surgery consultation decreased from 10.5 days to 3.6 days,” Chao and coauthors write. The percentage of patients who saw a breast cancer surgeon and a plastic surgeon on the same day increased from 6.5% before the CBC was opened, to 50% afterward.

Uptick Seen in Rate of Immediate Breast Reconstruction

For women who underwent mastectomy, the CBC approach increased the rate of immediate breast reconstruction: from about 40% to more than 52%. In this group, the time between the plastic surgery visit and mastectomy/breast reconstruction decreased from about 42 days to 30 days.

Rates of important types of complications after breast reconstruction surgery were about the same before and after the CBC approach, the study showed.

The new experience suggests that large hospitals transitioning to the CBC approach may be able to offer breast reconstruction to more patients, with shorter times to plastic surgery referral.

“A new diagnosis of breast cancer can be distressing for a patient, and every day that passes between the time the diagnosis is made and the time treatment is administered can increase a patient’s anxiety,” Chao and coauthors write.

In the CBC approach, breast reconstruction consultations for new patients were scheduled in the afternoon, to enable more patients to have their surgical oncology and plastic surgery visits on the same day.

The researchers also note that the CBC approach was “financially sustainable” for their hospital, even after the investment in resources devoted to breast reconstruction.

“The evolution of CBCs are a step in the right direction for everyone involved. These centers bring together all the physicians involved in the care of the patient, allowing for a more coordinated approach,” says Anne Taylor, MD, a clinical assistant professor of surgery with the Ohio State University Department of Plastic Surgery. “The research from the OSU Center shows us that this allows for better and more timely delivery of care. For the patient, this means better convenience for sure, but also better outcomes I believe, because of the close coordination. Finally for the insurers, the coordination should lead to lower costs.”