I criteri EUSOMA e l’accreditamento delle Breast Unit

Laura Biganzoli

Oncologia Medica - Istituto Toscano Tumori - Prato&

Consiglio Direttivo Eusoma

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Structure

• Breast Centre definition

• Organisational model

• Services and equipment

• Health professionals

• Working modalities

• Quality control

CORE TEAM

NON CORE TEAM

It is the place where breast cancer is diagnosed and treated. It has to provide all the services necessary, from genetics and prevention,

through the treatment of the primary tumor, to care of advanced disease, palliation and survivorship.

The Breast Centre is made up by a cohesive group of dedicated breast cancer specialists working together as a multidisciplinary

team with access to all the facilities required to deliver high quality care throughout the breast cancer pathway. This group does not

necessarily have to be a geographically single entity, as the Breast Centre can be made up by services and specialists from more than

one hospital, within the same geographical area, allowing for close multidisciplinary working and guarantee easy access to all the

necessary services.

Breast Centre

Objectives To describe the effect of multidisciplinary care on survival in women treated for breast cancer

“… after multidisciplinary care was

introduced breast cancer mortality was

18% lower in the intervention area than

in the non intervention area”

EVIDENCE

General requirements

• Official formal document (that complies with any national regulation) that demonstrates the set-up of the Breast Centre

• Critical mass

• Clinical lead

• Protocols

• Audit

• Multidisciplinary case management meetings

• Screening

• Communication of the diagnosis, treatment plan and waiting time

• Patient information

• Teaching

• Research

Wilson et al. Eur J Cancer 2012

Core team

Equipments, N. of dedicated specialists/ working time/workload

−Breast radiology

−Breast surgery and reconstructive surgery

−Breast pathology

−Breast medical oncology

−Breast radiation oncology

−Breast care nursing

Other services and non-core team

−Clinical genetics clinic

−New patients clinics

−Advanced breast cancer clinics

−Second opinion

−Psycological support

−Follow-up

−Prosthesis

−Physiotherapy and lymphoedema

−Nuclear medicine

−Palliative care

Wilson et al. Eur J Cancer 2012

- Integrated Breast Centre - Sufficient number of cases- Dedicated specialists- Working with a multidisciplinary approach- Providing all services throughout the patient pathway- Data collection and audit

Basic criteria

Critical mass

• A Breast Centre must be of sufficient size to have at least 150 newly diagnosed cases of primary breast cancer (at all ages and stages together) coming under its care each year, on a population base of about 250.000

− to maintain expertise for each team member

− to ensure cost-effective working

Wilson et al. Eur J Cancer 2012

• Purpose: To compare processes of care and survival for breast cancer by hospital volume

• Conclusion: Survival benefits reported in high-volume hospitals suggest a better application of recommended processes of care, justifying the centralization of breast cancer care in such hospitals

EVIDENCE

Number of cases 5 year survival

< 50 cases 74,9% HR 1.26(95% CI 1.12-1.42)

> 150 cases 83.9%

The Breast 2012

Multidisciplinary case management meetings (MDM)

• The Breast Centre must hold at least weekly a MDM to discuss diagnostic preoperative and postoperativecases, as well as any other issue related to breast cancer patients, which requires multidisciplinary discussion

Wilson et al. Eur J Cancer 2012

“ The results of the current study demonstrate that the multimodality approach can provide important additional information, allowing expert opinion and

recommendations based on the most recent research findings in 1 setting, resulting in changes in patient

management ”

EVIDENCE

Newman et al. Cancer 2006

Audit

• Database for the purpose of monitoring quality indicators

• Performance and clinical protocol review meetings to monitor the Centre’s data

• Participation in external benchmarking activities, (the comparison of Centre’s results with those of other Breast Centres)

Wilson et al. Eur J Cancer 2012

Set of quality indicators

that should be routinely

measured and evaluated

to confirm that the clinical

outcome reaches the

requested standards

17 QI (14 mandatory)

7 on diagnosis

4 on surgery and

locoregional treatment

2 on systemic therapy

4 on staging, counselling,

follow-up and rehabilitation

Certification

“Procedure through which a third party giveswritten certification, that a product, process or

service is in compliance with the specifiedrequirements”

UNI CEI EN ISO/IEC 17000:2005