New Breast Cancer Standards Emphasize Individualized Patient Care

Newswise — CHICAGO: To address the unique needs of today’s patients with breast disease and breast cancer, the American College of Surgeons (ACS) National Accreditation Program for Breast Centers (NAPBC) has released new standards for accredited centers that place patients and their care journey — from diagnosis to survivorship — at the center of the framework.

The revised standards represent a paradigm shift to put the individualized needs of patients first.

“Most standards and guidelines are written by physicians for physicians. When we were charged with rewriting the standards, we decided to flip that script to put the patient in the center of the framework,” said Jill Dietz, MD, MHCM, FACS, Vice-Chair of the NAPBC and lead author of the new standards. “So instead of recommending what the surgeon or medical oncologist should do, these new standards are really about focusing on the patient and what they experience throughout their treatment and afterward.”

Patient-Centered Focus

Programs accredited by the NAPBC follow a model for organizing and managing a breast center to facilitate multidisciplinary, integrated, and comprehensive breast cancer services.

Approximately 575 centers and hospitals across the country are accredited by the NAPBC.

These centers are committed to providing high-level breast cancer care to patients. Though the previous standards, which were last revised in 2018, addressed surgical care issues through an interdisciplinary lens, they were largely focused on procedures and thresholds such as the percentage of breast conservation surgeries versus mastectomy. Together with a team of multidisciplinary experts, including site reviewers, patient advocates, and NAPBC board members, a leadership group frequently met for more than two years to revamp the standards from the patient perspective.

The group also sought input from survivors of breast cancer, who described their lived experiences and the many challenges they faced, both during treatment and long after.

“We went out and talked to patients diagnosed with breast cancer and asked them about the things that troubled them the most. Most of their answers had nothing to do with the treatment that was provided. It had to do with waiting, or with their survivorship and feeling that no one cared anymore, or that their children looked at them differently. These were things that patients were experiencing that were not addressed in the old standards,” Dr. Dietz explained. “All of those pieces impact a patient and we need to be thinking about that.”

The revisions come at a time when treatments for breast cancer continue to advance every day, but there is variable access to care¹ across communities and the overall quality of life of breast cancer patients remains challenging to address.²

“I think that change starts in a place of curiosity in that we can’t presumably know what’s important to someone, what they’re worried about, or what they’re hopeful for, without asking,” said Arif Kamal, MD, MBA, MHS, an oncologist and Chief Patient Officer of the American Cancer Society.

Dr. Kamal was not involved in rewriting the standards, but he noted that shifts toward understanding the patient experience can dramatically improve the overall quality of life for patients.

“Specific to breast cancer, the standard of care was radical mastectomy for decades. The only reason that changed is because smart leaders in the field began raising concerns about the high incidence of lymphedema and morbidity after surgery. They started asking, ‘If we do less, can we still do just as well?,’” he said. “We found that getting away from radical mastectomy did just that. That story was not about making something more convenient for the healthcare system or the surgeon. The story was about the person.”

Revised Standards Focus on the Patient Journey

Some of the standards were unchanged and were reordered to fit the nine-domain format of other ACS Quality Programs. Other standards were completely rewritten to focus on the patient care journey from screening and prevention, to diagnosis, treatment, and survivorship, with an emphasis on providing value-based care with multidisciplinary support.

Some of the most significant changes appear in Chapter 5: Patient Care: Expectations and Protocol. Some notable changes include asking centers to:

• Involve patients in the decision-making process every step of the way and ensure they have the necessary educational materials to make the best decisions for their care
• Identify potential barriers that may prevent optimal patient care and try to preemptively address complications that may arise after surgery or treatment, such as mobility concerns or lymphedema
• Focus on preparing patients for surgery and treatment in a comprehensive manner
• Refer patients to prehabilitation, exercise therapy, or physical therapy when appropriate
• Develop and implement a protocol to address patient navigation throughout the patient journey
• Consider alternatives to narcotics for postoperative pain management
• Discuss and document the benefits and risks of cancer treatments with the patient, including toxicities

“These are things that we really didn’t focus on in the old standards,” said Katharine A. Yao, MD, FACS, Chair of the NAPBC and Director of the Breast Surgical Program at NorthShore University HealthSystem in Evanston, Ill. “In breast cancer, we often focus on hospital-centered outcomes such as recurrence rates, length of stay, or complication rates, but oftentimes, things such as satisfaction with care and overall quality of life matter more to patients. If patients can’t walk after their treatments or can’t lift their arm, that doesn’t give the patient a good quality of life, even if the recurrence rate is low.”

The team also hopes that the new standards reduce unnecessary administrative burden and help centers refocus to consider the evolving needs of patients with breast cancer.

“A cancer diagnosis is a life-changing experience for patients, and we need to be there for them and take deep consideration of what their life is like once they enter our world,” said Scott Kurtzman, MD, FACS, immediate past Chair of the NAPBC and a general surgeon at Waterbury Hospital in Waterbury, Conn. “I think these standards will drive new ways for centers to approach the patients that they’re taking care of and think about the people they treat in a more focused way.”

Implementation Timeline and Resources

All NAPBC-accredited programs must comply with the new standards by January 1, 2024. The NAPBC will provide guidance and education regarding the new standards and future site visits throughout the 2023 calendar year. Many resources are available online to assist centers:

• Optimal Resources for Breast Cancer Care (2024 Standards)
• 2024 Standards Crosswalk
• 2024 Standards Changelog

More information about the NAPBC is available on the ACS website.

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¹Crown A, Fazeli S, Kurian A, et al. Disparities in Breast Cancer Care: Current State of Access to Screening, Genetic Testing, Oncofertility, and Reconstruction. Journal of American College of Surgeons. DOI: 10.1097/XCS.0000000000000647.

²Hahn E., Munoz-Plaza C, Pounds D, et al. Effect of a community-based medical oncology depression screening program on behavioral health referrals among patients with breast cancer: a randomized clinical trial. JAMA 327.1 (2022): 41-49. DOI:10.1001/jama.2021.22596.

About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 84,000 members and is the largest organization of surgeons in the world. “FACS” designates a surgeon is a Fellow of the American College of Surgeons.