One in eight women will personally battle breast cancer at some point in life, according to the National Cancer Institute. In 2012, there were an estimated 1,460 total cases in Bexar County, and specialists at Methodist Healthcare provided care for approximately 1,000 women from Bexar County and beyond.
Facing surging incidence rates and increasingly complex treatment plans, physician leaders and Methodist Healthcare leadership have recognized the necessity of an integrated, comprehensive approach, emphasizing physician leadership and patient-centered care.
“We have implemented a collaborative model for physicians and hospital leadership to engage in an open dialogue for continuous improvement of services, quality and patient experience,” says Jonathan Tinker, Regional Vice President for Cancer Services at Methodist Healthcare.
Setting the Standard
The system’s reputation for providing the highest levels of care began 50 years ago, when Methodist Hospital opened its doors. During the last half-century, the criteria of excellence cultivated at Methodist Hospital has spread throughout the system and influenced the way health care is practiced in south Texas and beyond.
An example of the historical strength is the concept of prospective breast tumor conferences, where a team of specialists discusses and determines the best treatment pathway for patients. Paula Larson, MD, Managing Partner of South Texas Pathology Associates, who helped spur the advent of these conferences in 1992, notes that they also cultivate a more effective synergy between colleagues.
“Through these conferences, I’ve learned a lot about what problems surgeons and radiologists face in breast cancer treatment,” Dr. Larson says. “Knowing other physicians’ challenges makes the care you provide better because you can help colleagues avoid these difficulties. The conferences facilitate communication and result in improved patient outcomes.” In addition to the breast conference at Methodist Hospital, biweekly breast conferences are also held at Metropolitan Methodist Hospital to serve patients from the downtown area. This conference is facilitated by Kathy Grove, MD, Medical Director of the Metropolitan Methodist Hospital Breast Center.
The team approach begins with women receiving screening mammograms at one of 12 South Texas Radiology Imaging Center facilities, conveniently located across the region. Specialty-trained radiologists perform state-of-the-art ultrasound and stereotactic breast biopsies. Tissue samples that are sent to a Methodist facility are carefully scrutinized by expert pathologists who have extensive training in interpreting breast cancer cases.
“Close to 1,000 newly diagnosed women with breast cancer had their pathology reviewed at a Methodist facility,” Tinker says. “With that volume of experience, women can have comfort that the correct diagnosis is called the first time.”
Lines of communication don’t stop at the conclusion of breast conferences. Dr. Larson notes that a strong sense of collaboration and open phone lines between pathologists, radiologists and oncologists promote correct diagnoses and effective care, even for the most complex cancer types.
At least two pathologists examine each biopsy core to corroborate radiologists’ or clinicians’ findings. Because the pathology group features fellowship-trained breast pathologists and only hires physicians with fellowship or specialty training in areas of expertise complementing the needs of patients receiving care at Methodist facilities, one set of eyes would account for expert precision, but the added safeguard bolsters diagnostic certainty.
In the same manner, pathologists often visit the radiology department to examine radiographic images of patients with excisions to ensure that all areas of interest are sampled and identified, and their relationships to margins are considered. This close working relationship facilitates fast turnaround times for diagnoses, which Dr. Larson explains is a key consideration for patients.
“We want to get the correct diagnosis right away because we know, following a biopsy, there’s a patient sitting at home beside herself wanting to know what’s going on,” Dr. Larson says. “So we try very hard to provide 24-hour turnaround service for most breast core biopsies. If I get a core to read on Friday, I do my very best to get that report out so the patient isn’t sitting at home over the weekend worrying about it.”
Steven Pisano, MD, Co-Founder of PRMA Surgery, has served on faculties of and received training from top national facilities, including University of Texas MD Anderson Cancer Center, and doesn’t shy away from praising the pathologists at Methodist Healthcare.
“Methodist Healthcare System has resources that include some of the finest pathologists in the country, and it doesn’t stop there,” Dr. Pisano says. “Along with pathologists, there are surgeons and oncologists on the leading edge in coming to the right diagnosis and performing surgery, ensuring we get the cancer out and all margins are clear. That’s where the rubber meets the road.”
From Dr. Pisano’s perspective, the pathology team distinguishes itself by identifying every nuance — which can include multiple lesions, margins too close to the skin or too unclear, and the need to surgically remove more tissue — in each case he sees.
The Methodist Difference
Following diagnosis and presentation of the case at a breast tumor conference, the treatment team takes action to fight breast cancer.
Brittany DeBerry, MD, partner with General Surgical Associates and Surgical Chair at Methodist Hospital explains, “There is no cookie-cutter solution for dealing with breast cancer. Every case we are presenting requires a specially tailored treatment plan. We work with referring physicians to determine specifics about each patient’s clinical needs, then collaborate across specialties to develop the most appropriate plan of care. Every surgery I perform is designed as not only the optimal treatment for breast cancer, but also the treatment that most aligns with the patient’s long-term goals.”
“You can have surgery anywhere, but here, everyone is compassionate and dedicated to providing only the most excellent standards of patient care — the same care we would want for ourselves and our families,” Dr. Grove adds. “That’s the Methodist Healthcare difference that is defined by staff and physicians who practice at Methodist facilities.”
Plastics: Innovative Reconstruction
Plastic surgery is an option for women following surgical excision of the cancer, Dr. Pisano and his partners perform innovative reconstructive surgeries such as the muscle-sparing deep inferior epigastric artery perforator flap procedure. During this procedure, which offers better recovery time and reduced postoperative pain compared with traditional reconstruction methods due to the lack of muscle disruption, he transplants tissue from the lower abdomen to the chest wall and reattaches blood vessels taken from the region to those in the chest using microsurgical techniques.
Only trained surgeons with an expert team of operating staff can perform this technically challenging operation, and few institutions not affiliated with university medical centers offer the option. Dr. Pisano estimates his group performs more than 500 during the course of a year, the vast majority at Methodist Hospital. There, the breast cancer nursing team has been assisting with this procedure for more than a decade.
“We perform state-of-the-art reconstructions in astonishing volumes,” he says. “We’re not dabbling. We’re not getting out the textbook to figure out how to perform the procedure because we only do it once a month — we do it multiple times per day.”
Navigating Complex Treatment
Physicians and hospital leadership worked together to add patient navigators to the staff, offering an additional layer of support for women embarking on the journey of cancer treatment. As part of the team, patient navigators play an integral part in maintaining an elite standard of care. Lorraine Infantino, RN, BSN, MSN, Certified Breast Health Nurse Navigator, located at Metropolitan Methodist Hospital, keeps patients on track to receive the care they need.
The navigator meets with patients upon receiving the initial phone call. From that point forward, Infantino serves as the primary patient contact, facilitating interactions and appointments with medical oncologists, surgeons and radiation oncologists, as well as plastic surgeons, to ensure patients have access to comprehensive care. In addition, the nurse navigator links patients to numerous survivorship and support groups offered by Methodist Healthcare or other organizations in the San Antonio region. The navigator also arranges transportation and secures insurance authorizations for those who need them.
Dedication and compassion — exhibited by the nurse navigator’s devotion to the patients — are salient qualities of the entire Methodist Healthcare System, according to Kathy Grove, MD. She notes that routine checkups take about 20 minutes, but for newly diagnosed breast cancer patients, Dr. Grove and the Breast Center staff at Metropolitan Methodist Hospital spend 90 minutes ensuring patients have all the information they need and know their physicians support them.
The long-standing model of excellence, complemented by layers of support within Methodist Healthcare, provides patients leading-edge, compassionate care. Physicians referring their patients to Methodist can rest assured their patients will receive the excellent care from the physicians and skilled breast care team that has set the bar for breast cancer care in San Antonio.
For more information about breast cancer treatment or to refer a patient, please visit www.SAHealth.com or call 210-575-0355.