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| HealthMonday, August 20, 2007 10:51 AM CDT |
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The sum of many opinions
Comprehensive Breast Service an asset to area cancer patients
NORMAL — Barb Nathan thinks women shouldn’t feel the need to leave Bloomington-Normal for breast cancer treatments. While Nathan, executive director of the Community Cancer Center in Normal, doesn’t know how many McLean County women have gone elsewhere for some of their breast cancer treatment, she is sure the numbers will decrease. The cancer center has enhanced its breast health services by developing the Comprehensive Breast Service. The service includes: The planning includes a breast cancer tumor board that meets each Thursday morning at the cancer center, 407 E. Vernon Ave., to discuss each new breast cancer case. The board includes medical oncologists, radiologists, radiation oncologists, pathologists and general and plastic surgeons who discuss treatment options, including surgery, chemotherapy and radiation. Each patient’s primary care physician also is invited. Jolene Clifford accepted the position after more than 10 years as a radiation oncology nurse. She sits in on breast cancer tumor board conferences, connects patients to needed services, answers their questions and provides support. “This is real and it works,” Nathan said of the comprehensive breast service. “It has truly made a difference in the treatment planning of a number of patients,” Nathan said. “Not that care was bad before. We’re taking something that was good and making it better.” Dr. John Migas, a medical oncologist, agreed. “The comprehensive breast service concept is starting to evolve,” said Migas, with Mid Illinois Hematology & Oncology Associates, which is based at the cancer center. “We are at the leading edge of it. “The bottom line is when you have a comprehensive breast program, it will lead to more accurate answers for the patient,” Migas said. Discussions began with breast cancer survivors and doctors a year ago on what the cancer center and community could do to ensure that the best breast cancer treatment was happening in Bloomington-Normal. “We started with breast cancer,” Nathan said. Similar efforts are expected later regarding other cancers, Nathan and Migas said. “For women who left the community for some of their care, we asked them what we needed,” Nathan said. “They said one-stop shopping (one place for cancer care), multidisciplinary treatment planning, timeliness (reducing the number of days between an abnormal mammogram and a tissue diagnosis) and a case manager.” While McLean County doesn’t have a single place for all breast cancer services, the cancer center comes the closest, offering services except mammography and surgery. So the cancer center took the lead in trying to better coordinate services. The cancer center’s general tumor board occasionally discussed a breast cancer case and there has been communication among doctors, Nathan said. “But what was frustrating to patients in the past was that care was fragmented,” Migas said. Each doctor did his or her job but communication among doctors regarding patient care was sometimes limited and delayed, he said. “I practice in my own realm and stay up to date in my area and so do the pathologists, the surgeons, the radiologists and so on,” Migas said. But it’s impossible to stay up on what other specialists are doing and that’s why communication is important. “One of the biggest complaints by patients of doctors is that nobody is talking to each other,” Migas said. Doctors have communicated but, in some cases, haven’t been as thorough or timely as they could have been, he said. The tumor board addresses that because the doctors involved in that patient’s cancer care are invited to be around the same table at the same time, Migas said. “It expedites care,” Esch said. “Sometimes, there is not initial agreement (among the doctors),” said Dr. John Esch, a Bloomington-based general surgeon. “Through discussion and debate, we all learn from each other and it helps each doctor to understand the others’ opinions.” “This is the best tumor board I’ve been involved with in my career,” Migas said. “Almost every time I go to tumor board, I learn something. We’re all working together. Sometimes, getting on the same page takes some discussion.” When doctors agree on a treatment plan, it’s solid and timely, Migas said. “I think, absolutely, it has changed care in some patients,” Esch said. “And having all the practitioners on the same wavelength instills a lot of confidence in the patient.” Migas said, “Some doctors aren’t there (on tumor board) yet but it’s pretty new. We hope to get every doctor involved in breast cancer treatment at tumor board.” Not only are independent physicians at breast tumor board meetings, but representatives of several institutions, including BroMenn Regional Medical Center, OSF St. Joseph Medical Center, Carle Clinic and Bloomington Radiology. About 15 doctors attend each meeting, Nathan said. Clifford is a registered nurse who received special training to be certified as a breast health navigator. “As a radiation oncology nurse (at the cancer center), I spent a lot of time with patients and bonded with them,” Clifford said. She developed a special interest in helping patients work through the treatment process, so she was interested when the breast health navigator position was created. In addition to talking with patients, Clifford meets with doctors, nurses, women’s centers representatives and others involved in each patient’s cancer treatment. “If I can help in the process, that ultimately benefits the patient,” she said. Bloomington woman shares positive experience with programBLOOMINGTON — The experience of Kaye McDonald Andrews illustrates the value of a comprehensive breast program and a breast cancer tumor board, agreed Andrews and her medical oncologist, Dr. John Migas. “Her experience is exactly the reason that tumor board is a good idea,” Migas said. “She had a complex situation. Many of the decisions made in her care resulted directly from doctors at tumor board talking with each other.” Andrews said, “My situation was not ordinary so the tumor board was instrumental in helping me to make decisions. I felt like they (the doctors and nurses) were all working for me and that they really care.” Andrews, 65, of Bloomington, is a former registered nurse at Heritage Manor, Bloomington, and a retired Realtor with Re/Max Twin City Realtors. Her health was excellent when she went in for her annual mammogram April 5 at Carle Clinic, Bloomington. A week later, Andrews received a call that Dr. Jason S. Davis, a Carle radiologist, wanted to do more tests. A second mammogram and ultrasound was done on April 13. “He told me that there was a tumor (in the right breast, about the size of a pea) that wasn’t there last year and he needed to do a biopsy to see if it was cancer or not.” Davis thought it was invasive ductal carcinoma, a common breast cancer that was treatable if caught early. A core biopsy guided by ultrasound April 17 confirmed Davis’ earlier diagnosis. But Davis found what he thought was a second tumor close to the chest wall, under the first tumor. On April 23, Andrews met with her primary care physician, Dr. Eric Duncan, then Dr. John Wieland, a general surgeon. Wieland looked at the mammograms, the ultrasound and reports. He couldn’t tell if Andrews had two pea-size tumors that were connected or one unusually shaped tumor. He suggested that she do research and consider whether she wanted a lumpectomy (in which the tumor and some surrounding tissue would be removed) with radiation, or a mastectomy, in which the entire breast would be removed. She considered going to Chicago because she wanted the latest treatment options but decided to get more information about local services first. On April 26, Davis discussed her case with Migas after a tumor board meeting. Later that day, Andrews went to the Community Cancer Center in Normal and met with a nurse educator and Jolene Clifford, who had just started as the center’s breast health navigator. She met with Migas, who consulted with Dr. Don Stacy, radiation oncologist. Migas suggested an MRI (magnetic resonance imaging) to determine how close the tumor was to the chest wall. Andrews had the MRI on April 27 at Ft. Jesse Imaging Center and got the results May 2. Results showed that she had a good margin, meaning there was space between the edge of the tumor and the chest wall. Andrews’ case was the subject of a tumor board meeting May 3. Doctors concluded the two- to three-centimeter margin meant that she could have a lumpectomy. “We were very delighted,” she recalled. Andrews met with Stacy to discuss radiation and with Clifford to discuss the treatment plan and nutrition and exercise. “Since then, I call Jolene with questions and she gets me the answers. Then I don’t have to keep bugging the doctors. It makes the process easier.” On May 15, Wieland performed a lumpectomy on Andrews’ right breast at Eastland SurgiCenter in Bloomington. What he removed was an unusual, dumbbell-shaped tumor, rather than two tumors. Wieland was able to remove most of the tumor but tests indicated that some microscopic cancer remained in the margin. Her choice was a mastectomy or opening the area of the lumpectomy again. Migas again took Andrews’s case before the tumor board, on May 23. The consensus was to try another lumpectomy. Wieland did the second lumpectomy June 5 and also removed a sampling of lymph nodes from the armpit to make sure the cancer hadn’t moved beyond the breast. “It came back no cancer cells in the re-excision site and none in the lymph nodes,” Andrews said. “When Wieland gave me the results (on June 8), I started to cry out of relief. It was a good day.” Migas confirmed the results the following day. “Everybody was communicating with each other and working in my best interest,” Andrews said. Without the comprehensive breast service, Andrews could have had a mastectomy or could have traveled to Chicago for treatment. Andrews does not need chemotherapy but begins radiation this month to kill any stray microscopic cancer cells. “I’m not excited about radiation. I know there are side effects involved. But the latest equipment at the cancer center means there’s less risk than before.” Her goal is to come out of cancer treatment healthier than before. Andrews’s recommendation to women just diagnosed with breast cancer reflects her involvement in her treatment and her experience with doctors and nurses here. “The more you learn about your unique situation, the less fear you have and the more involved you get in your treatment.” E-mail this story | Print this story | Search archives | RSS Show comments |  Hide comments | Hide comments on all stories |
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