Same-day diagnosis reduces patient
anxiety at breast cancer clinic
What if you had to wait 37 days for a breast cancer diagnosis?
“That’s way too many opportunities to Google a hypothetical scenario,” says Terri Stuart-McEwan, Executive Director of the Gattuso Rapid Diagnostic Centre (GRDC) at the Princess Margaret Cancer Centre, part of the University Health Network (UHN).
Today, the GRDC has reduced breast cancer diagnostic waiting times from an average 37 days to 24 hours.
What began as a pilot project in 2006, led by Dr. David McCready, The Gattuso Chair in Breast Surgical Oncology, has grown from a one-day clinic to a centre that, as of last July, now operates five days a week. The centre sees 30 patients each week and 1,500 every year. Since it began, more than, 2,300 patients have been through it, and in 2011 Accreditation Canada recognized GRDC as a leading practice.
“The main advantage of the centre is to be able to plan your life and reduce the anxiety of not knowing,” says Dr. McCready, head of the breast cancer program and a Professor of Surgery in the Faculty of Medicine, University of Toronto.
The GRDC provides patients who have been referred by a family physician with a ‘one-stop centre’ for same-day clinical breast exam, mammogram, ultra-sound, biopsy, and clinical evaluation. In this nurse-led clinical model, nurse practitioners help patients navigate the diagnostic journey by facilitating access to an inter-professional team, including a radiologist, pathologist, surgeon, oncologist, and other allied health professionals.
Since 2010, the GRDC has invested in state-of-the-art equipment in pathology and radiology, including three digital mammography machines with tomosynthesis workstations to detect cancers more quickly. This reduces the number of possible irregularities detected by current mammograms, sparing women from having to return for additional imaging.
A typical visit to the GRDC may look like this: the patient arrives at 8 a.m. and is evaluated by a nurse practitioner who works with the radiologist to develop an investigation plan. The next step is completion of an ultrasound and biopsy (if required) by 9:30 a.m. The patient has a few hours to review the literature, grab a coffee, phone a friend or visit the survivorship centre. By 2 p.m., the patient returns to the clinic to receive a diagnosis. If it’s cancer, the inter-professional team develops a personalized treatment plan for the patient and, if required, books surgery.
Long diagnostic waiting periods can cause psychological distress for patients, families and friends. “The literature is clear – waiting is very anxiety-provoking for patients,” says Stuart-McEwan. “We are helping to reduce those sleepless nights.”
This new model is designed to reduce prolonged, fragmented patient visits, and instead, create a coordinated, patient-centered experience. The centre looks at the full patient journey, including surgical wait times. According to Cancer Care Ontario’s wait time surgical benchmarks, patients can expect a waiting timeline of 28 days from the time the decision is made to have surgery, to the procedure itself. At the GRDC, this timeline has been reduced to 19 days. The centre has also developed key partnerships with Women’s College Hospital and St. Michael’s Hospital to increase the number of surgeries and other procedures for patients diagnosed with breast cancer.
Moving beyond breast cancer
The success of rapid diagnostic model in breast cancer is inspiring other UHN programs to review traditional practices and procedures. A diagnostic assessment program is now being developed for pancreatic cancer patients, the Lung Rapid Assessment and Management Program (LungRAMP) and Acute Leukemia program – all dedicated to creating an integrated diagnostic journey for patients.
Major funding for the GRDC was provided by Emmanuelle Gattuso, a breast cancer survivor, and her husband, Allan Slaight. Since 2009, the couple has donated and fund-raised $25 million to The Princess Margaret Cancer Foundation for the centre. The RBC Foundation has also donated $1.25M to the development of the centre. The initial pilot project was funded by participants in The Weekend to End Breast Cancer (now The Shoppers Drug Mart Weekend to End Women’s Cancers).
To learn more about the Gattuso Rapid Diagnostic centre, visit: http://www.theprincessmargaret.ca/en/PatientsFamilies/ClinicsAndCentres/RapidDiagnostics/Pages/about-us.aspx