An initial diagnosis of breast cancer will precipitate an acute crisis
situation for the affected patient. The patient must cope with her
uncertainties, feelings of despair and fears for the future. She will constantly be
beset by worries about her own health, her family, her work and career, fears about
potential pain, suffering and disability, but she will also hope to be cured.
At present, the multimodal treatment of breast cancer offers better chances of
recovery than ever before. In a first step, the patient will attend a clinic
in a certified breast centre where she will be informed, during the course of
several lengthy and comprehensive informative conversations, about the treatment
choices available and the type of treatment recommended in her individual case. The
patient must make decisions with significant and far-reaching consequences, e.g.
about her primary surgical treatment, neoadjuvant medical therapy, the necessity for
primary sentinel lymph node biopsy, the choice of breast-conserving therapy or
mastectomy with and without reconstruction at this point or at a later date.
Radiation therapy is also part of therapy planning, and patients must also be
informed about new treatments such as hypofractionated and intraoperative radiation.
Providing information about the possibility of taking part in controlled trials is
as important as weighing up the necessity for adjuvant chemotherapy based on modern
prognostic factors such as tumour proteases and multigene signatures. And finally,
the patient needs to be informed about the effectiveness of anti-hormone therapy in
addition to or instead of systemic chemotherapy. Patients are rarely able to process
all the information they receive from their physician immediately and
completely.
On the other hand, these informative conversations can help to allay her fears step
by step and allow her to carefully consider her decisions and talk them over with
her family, friends and family physician. Crucial for the outcome of therapy in
individual cases will be the extent to which the professional team of surgeons,
psycho-oncologists, oncologists and radiotherapists can obtain the patientʼs trust
when making the decision for the best treatment.
The improvements in the surgical treatment of breast cancer mean that operative
procedures are increasingly breast-conserving and sparing. There can be no doubt
that this facilitates postoperative healing and can shorten the time spent in
hospital.
Active physical rehabilitation starts on the first postoperative day. Once the
histo-pathological findings and the staging have been completed and the predictive
factors have been assessed, the overall oncological situation of the
individual patient is discussed in an interdisciplinary conference. A therapy
concept is developed in the tumour conference with the collaboration of all
disciplines involved; it takes account of current guidelines and the patientʼs
individual situation (age, pre-existing medical conditions, therapy preferences,
medication, family and work situation, etc.).
This interdisciplinary approach to diagnostics and therapy focuses not only on
diagnostics, surgical therapy and nursing care but develops an overall
oncological concept, which also includes taking account of psychosocial
stresses. These tasks are currently the remit of the certified breast centres. The
structures are only available in an inpatient setting and inpatient
therapy is therefore necessary. For breast centres, a minimum stay of 4 days
inpatient treatment is envisaged, it cannot be shortened without jeopardising the
patientʼs chances of recovery.
The efforts by health insurance companies to treat early stage “small breast cancers
requiring limited surgery” on an outpatient basis runs contrary to these
quality specifications, ignores the requirements for overall care and directly
contradicts the reality of care as described above.
Surgical procedures performed on an outpatient basis are therefore viewed extremely
critically by the professional associations, in particular by the DGGG and patient
organisations, because they do not comply with and adhere to these quality criteria
and reduce the treatment of breast cancer to a brief surgical procedure.
On behalf of the above professional associations, work and study groups
Prof. Dr. Th. Beck
Rosenheim
Spokesman of the AG Z BZ
