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Melanie Cole (Host):  Welcome. This is the podcast series from Deaconess, The Women’s Hospital – A Place For All Your Life. I’m Melanie Cole. And today we’re discussing the multidisciplinary breast cancer program at Deaconess. Joining me is Dr. Samer Schuman. He’s the Medical Director of Gynecologic Oncology at the Women’s Cancer Center. Dr. Schuman, I’m so glad to have you join us today. what a great topic. Tell us a little bit about the specialty of providers that serve on this multidisciplinary team. How do they all work together?

Samer Schuman, MD, FACS, FACOG (Guest):  As far as the specialty of providers that serve on the multidisciplinary team, we have breast surgeons, medical oncologists, radiation oncologists, plastic surgeons, genetic counselor, nurse navigator, social workers, pharmacists, essentially every specialty that needs or may need to be involved in the care of the breast cancer patient.

Host:  Wow, that’s a very comprehensive approach. What’s your role Dr. Schuman in the team?

Dr. Schuman:  I serve two roles in this program. First, being the Medical Director of the Breast services at the Women’s Hospital; I provide oversight of the multidisciplinary breast program both clinically and operationally. As a breast surgical oncologist, I am an active member of the multidisciplinary breast cancer team. so, I work with the rest of the team members to provide comprehensive treatment plans for our patients.

Host:  How was this multidisciplinary approach to breast cancer care established at Deaconess The Women’s Hospital?

Dr. Schuman:  It was certainly a consorted team effort. The main driver was the need to deliver better quality of care to our patients. As you know, treatment of cancer is very complex, and it involves physicians from different specialties most of the time. It requires extensive real-time discussions between specialists and this complexity unfortunately leads to failure to diagnose and treatment delays in some situations. So, when I joined Deaconess The Women’s Hospital in 2012, I felt that we need to change the approach to breast cancer care so we can deliver a superior quality. There’s always room for improvements in any situation and we felt that we can improve on the good quality of care that was already there.

So, as a consequence, I consulted with all the stakeholders that are involved in breast cancer care. I met with administration, medical oncologists, the breast surgeons, radiation oncologists, plastic surgeons, navigators, radiologists, pathologists, you name it. We talked to everyone and anyone that may be involved in the care of breast cancer patients closely or remotely. So, as a consequence of all these meetings and discussions, we decided to change the organization of our breast cancer care system or program that we had.

We decided to move away from that siloed organization by specialty departments. As you know, specialty departments are things like surgery, medical oncology, radiation oncology. These are organized individually. And we wanted to organize around the patient’s medical condition and in this case, it is breast cancer. And with this new organization, which we called the multidisciplinary breast cancer program; a dedicated team made up of both clinical and nonclinical personnel provide the full-cycle of care for patients with breast cancer. It draws from all these different departments and we bring them around the patient.

Host:  That’s really a wonderful approach. Can you walk us through the process of the multidisciplinary breast cancer program Dr. Schuman?

Dr. Schuman:  Melanie, before we do that, to understand the value of the current process of multidisciplinary breast cancer care, I need to take you through the process from prior to the multidisciplinary breast cancer program. And that’s probably the approach that is most common nationally and everywhere. So, our approach before this program was sequential and organized by the specialty departments like we talked about. And this is like the majority of breast cancer care around this country.

The journey starts with the primary care physician as you know or the OB-GYN who does or orders a screening mammogram. This mammogram is read by a radiologist. The same or another radiologist recalls the patient for a diagnostic workup and possible biopsy. The pathologist would read the biopsy. The patient is then referred to a surgeon for surgery. If there is breast cancer, the surgeon refers the patient to a medical oncologist. Chemo is given for several months in some situations. Then the medical oncologist might see that the patient needs a referral to radiation oncology, so she sees the radiation oncologist for radiation treatment. I did not mention that many patients require genetic counseling and testing with a genetic counselor as well as a plastic surgeon for reconstruction. Sometimes physical therapists to help with lymphedema or their range of motion, et cetera, et, cetera.

This sequential approach which is currently the most common way of practice around the country leads unfortunately to treatment delays, fragmentation of care, poor communication among all these providers. I listed a large number of providers involved. To communicate amongst each other requires a lot of effort. Increased errors, duplicate testing, sometimes a test needs to be repeated because of the length of the process, unclear treatment plans to the patient or other providers that are involved in the plan. This leads to patient’s anxiety or increased anxiety and decreased patient as well as physician satisfaction.

So, we felt that that current situation at that time can be improved. We felt that with the same resources that we have, we can deliver better quality of care. And that’s when we decided to offer our patients a prospective multidisciplinary approach as opposed to a sequential approach. So, how does this work?

Every Friday morning, a team of dedicated breast specialists and we talked about those breast surgeons, medical oncologists, radiation oncologists, plastic surgeons, pathologists, radiologists, genetic counselor, we have navigators, social workers, nutritionists, pharmacists et cetera; they all meet in a conference room between 7:30 and 8:30 in the morning to discuss the patients that were referred to the multidisciplinary breast cancer program while the patients are being checked into exam rooms. After the conference, the specialists that need to see the patient walk into the patient’s room to examine and counsel the patient.

Once that is done, the group comes out with a written comprehensive treatment plan that addresses all the aspects of the treatment, there is surgery, chemotherapy, endocrine therapy, radiation, reconstruction, genetic testing, social needs, et cetera.

This document is shared with the patient and her referring physician and the entire team. So, in other words, in a single visit, the patient gets the input from all the providers that may be involved in her entire breast cancer care from the beginning to the end of treatment.

Host:  That is absolutely amazing. And what a wonderful approach to patient care, that the patient themself is at the center of all of you experts and specialists. That really is amazing. So, how do you feel this approach to care puts patients at the center of their care and gives them that autonomy and decision making and that they are involved in their own care which has got to help their breast cancer treatment.

Dr. Schuman:  Absolutely. And as you discussed, we bring together the entire team around the patient in one setting. The patient, in our view, is not only at the center of care but part of this team. they get a much better understanding of what the entire episode of care from the start to the finish would look like which will allow them to ask better questions and be a true advocate of their own health.

Host:  Well that certainly is one of the most important aspects. So, tell us a little bit about what you’ve seen as far as outcomes for the women. How has this program reduced the time between diagnosis and treatment of breast cancer? How has it helped the woman mentally and psychosocially to go through what is a pretty scary time for women?

Dr. Schuman:  Absolutely. Melanie, we measure a lot of outcomes in our program. And one of the outcomes that we measure is the time from diagnosis to establishing this multidisciplinary treatment plan. And we also measure the time from diagnosis to the start of the treatment. And we found compared to the prior approach, we found a 62% and a 58% reduction in those numbers respectively. So, this is a significant reduction in the time from diagnosis to the treatment plan and from diagnosis to the start of treatment which in our opinion and it’s well known as well that the earlier you start the treatment, the better the outcomes are in general. Moreover, the things that are very important with this concept is it’s always a group decision and as we know, the group decision is more intelligent than individual’s decisions. It has shortened the time from diagnosis to treatment, from diagnosis to development of a multidisciplinary treatment plan but not only that, it improves the communication amongst providers and between the providers and the patient. It decreased variability.

So, we are all on the same page. All the providers have just right now discussed this patient’s case and they walk out fresh in their minds, they are all on the same page. It decreases the fragmentation of care. It decreases the ordering of duplicate testing that is unnecessary. It provides a cohesive, clear, evidence-based treatment plan and all of this improves the patient satisfaction. The patient does not need to do so many visits at different locations and lost time off work. It creates a consistent communication among providers, and it saves the patients cost and money and time off work and provides them with a one time approach where they can see the entire plan from the beginning to the end and have a very good understanding of that.

Host:  I can certainly see how that would be so beneficial and really help that patient’s journey and their outcomes when they are dealing with breast cancer. Please summarize it for us Dr. Schuman, your amazing multidisciplinary breast cancer program at Deaconess The Women’s Hospital what you’d like women and referring physicians to know about it.

Dr. Schuman:  I would like women in general and the referring providers to know that this program is available for them in our community. It is not only a great program, it’s a program where the quality of care is much higher than the usual approach because of all the things that we discussed. The patients will be very well taken care of. They will feel very comfortable when they leave our office that day that they understand that what is coming their way, what is their entire treatment is going to look like over the next six months. Not only that, they are being cared for by physicians and providers that specialize in breast cancer and make this something that they do every day, day in and day out and they will have the best care available for them in their community right here in Evansville.

Host:  They certainly will. Thank you so much Dr. Schuman. You are a lovely man and I can hear the passion in your voice when you talk about this program that you helped to create. Thank you so much for coming on and telling us about it. It really is marvelous. Thank you again. That concludes this episode of The Women’s Hospital – A Place for All Your Life. If you are diagnosed with breast cancer, please ask your doctor for a referral to the multidisciplinary breast cancer program at Deaconess. To learn more and to schedule an appointment, please visit www.deaconess.com/breastcancer to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other Deaconess Women’s Hospital podcasts. I’m Melanie Cole.