Authors (including presenting author) :
(1) Dr. Edward Hui, Dr. Ling YH, Ms. Monica Ng, Ms. Leung WY (2) Dr. Kan PG, Dr. Mok KL, Leung CP, Wong CW, Lam KY, Leung SM
Affiliation :
(1) Department of Surgery, (2) Accident and Emergency Department, RTSKH
Introduction :
Breast cancer is the third commonest cause of cancer deaths among women in Hong Kong. Patients with suspected breast cancer would be fearful and anxious about the uncertainties of their condition. Priority Breast Clinic (PBRC) services jointly operated by RH A&E and Department of Surgery, could make a positive contribution to the quality of breast cancer care by providing fast-track diagnostic services and prompt treatment.
Objectives :
To implement a new referral system for patients with suspected breast cancer in RH A&E, to expedite their waiting time for surgical assessment, to speed up the diagnostic process, and to streamline clinical management.
Methodology :
PBRC was launched on 2 July 2019. Patients with signs suspicious of Breast cancer (e.g., breast mass, blood-stained nipple discharge, suspicious breast imaging results, and previous histological proven breast cancer or phyllodes tumor) would be directly referred to PBRC by A&E doctors. Patients could receive one-stop fast tract services in the surgery day ward to achieve early diagnosis, including clinical examinations, arranging earlier breast imaging or reviewing breast imaging results if available, bedside ultrasound, ultrasound-guided core biopsy and fine-needle aspiration for suitable cases. A newly designed workflow was introduced in A&E. The overall waiting time for making a diagnosis and receiving treatment was used to evaluate the effectiveness of the program.
Result & Outcome :
There were 30 referrals from 2 July 2019 to 31 December 2019, 12 (40%) cases were diagnosed with a malignancy or phyllodes tumor, 4 (33.3%) had upfront operation. Of the remaining 8 (66.7%), 3 (37.5%) with locally advanced disease received neoadjuvant therapy, and 1 (12.5%) received palliative chemotherapy due to metastatic disease, 1 (12.5%) dropped out, 1 (12.5 %) received conservative treatment, and 2 (25%) were planning for treatment. The mean age was 47.7 years (range 19- 95). The waiting time for surgical specialists’ consultation was shortened from around 14 days in “Priority 1” SOPD booking to an average of 7.7 days (range 1-27 days).
With close collaboration with the Department of Surgery, this newly implemented program showed a significant improvement in efficiency and effectiveness in providing appropriate care to the patient with suspicion of Breast cancer.
