Abstract P3-10-10: Planning and implementation of two regional one-stop breast health centres within a large geographic health authority: Outcomes and quality improvements in health service delivery
Authors: Martin LA , Janzen R , Wong F , Doris P 
Published: March 2017

Abstract
Interrogative examination of wait times for the pathway steps leading to diagnosis, surgical treatment, and oncology consultation for breast cancer within a geographically dispersed publically funded health authority led to advocacy for and establishment of two large one-stop Breast Health Centres (BHCs) within the largest urban cities. One year after publication of the 2000 EUSOMA guidelines for breast cancer diagnosis and treatment, regional breast cancer pathways and wait times did not meet guidelines. Population median wait time from date of first investigation to tissue diagnosis was 2.7 or 5.9 weeks (for clinical presentation or screen presentation respectively), 6.0/7.0 weeks to definitive surgical intervention, and 14.3/11.7 weeks to oncology consultation. Only 39 % of patients were diagnosed initially via core needle biopsy. 5 % of patients underwent immediate reconstructive surgery. Due to wait times for initial imaging (mammogram, ultrasound) at hospital facilities, baseline imaging was often performed at private imaging labs without needle diagnostic capability, and repeated again with a series of wait times at the hospitals - as the initial community images were not accessible to the hospital interventional radiologists. Smaller communities and their hospitals maintained shorter wait times in comparison to the large urban centres. Repeat population based measurement in 2009 indicated wait times were unchanged, and MRI guided biopsy was still not available within the region. Nursing support and patient education re breast cancer prognosis and treatment was not available until the time of oncology consultation.
BHCs were planned, funded by the Ministry of Health, established in physical conjunction with the breast screening programs, and became operational as of early 2012. During the first year of BHC operation, population median wait time from date of first investigation was 2.0 weeks for tissue diagnosis, 6.4 weeks for final definitive surgical intervention, and 9.4 weeks for oncology consultation. 90 % of patients were initially diagnosed via initial core needle biopsy with IHC staining for ER, PR, and HER2. Patients served by the BHCs had nurse navigator support and education from time of presentation. The surgical team overcame regional surgical wait time barriers such as available admission beds by establishing the first comprehensive population-based outpatient mastectomy and reconstruction program in Canada with over 1200 performed to date. These wait times have been maintained in spite of increase in the HA population from 1.2 million to 1.6 million during the project timeline.
Citation Format: Martin LA, Janzen R, Wong F, Doris P. Planning and implementation of two regional one-stop breast health centres within a large geographic health authority: Outcomes and quality improvements in health service delivery [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-10-10.