The Susan G. Komen Breast
Cancer Foundation joins author
Dr. Barbara Rabinowitz in underscoring
the importance and value
of interdisciplinary/multidisciplinary
breast care. We agree, as well, that
the multimodal approach that Dr.
Rabinowitz carefully outlines in her
article should be adopted more consistently
and recognized as this nation's
standard of breast care. Her
article provides the perspective needed
to understand why this is so.
Benefits of the
Multidisciplinary Approach
As Dr. Rabinowitz indicates, the
multidisciplinary approach to the care
of breast cancer patients not only promotes
expeditious teamwork among
doctors from various disciplines, it allows
complex treatment approaches to
be debated in an intellectually open
and rigorous manner. The benefits to
the patient, in terms of well-designed
treatment plans, convenience, and confidence
in overall care, are enormous.
It is important to include the patient
in decision-making throughout
the treatment continuum. Multidisciplinary
care allows this, promoting a
sense of patient empowerment and
self-determination. As a result, patients
feel that all possible treatment
avenues have been explored and that
the merits of choosing one direction
over another have been carefully considered.
This approach has a built-in
component for the second opinion
many patients want, but for which
many are afraid to ask.
As Dr. Rabinowitz mentions, the
addition of a dedicated "breast health
specialist" can serve as the glue that
holds the entire medical team together,
keeps treatment moving forward,
and helps the patient to remain well
informed of all decisions. In addition,
these professionals can provide safe
harbor for patients who become
fearful or lose heart in the midst of
a lengthy and rigorous course of
treatment.
Komen Foundation Activities
The Susan G. Komen Breast Cancer
Foundation, one of the nation's
best-known breast cancer advocacy
groups and the nation's largest private
funding source for breast cancer
research and community outreach programs,
is committed to eradicating
breast cancer as a life-threatening disease
through the advancement of research,
education, screening, and treatment.
Breast cancer is a complex disease
for physicians to diagnose and
treat, and it presents equally complex
challenges for patients. In our comprehensive
approach to breast cancer,
we are committed to never losing sight
of the special needs of the person receiving
the cancer diagnosis.
In 1998, the Komen Foundation
and breast cancer experts at The University
of Texas (UT) Southwestern
Medical Center at Dallas recognized
the growing need to provide more
multidisciplinary education in breast
cancer care. Together, we developed
a pilot program designed to provide
physicians with a broad array of training
experiences through rotations in
all medical disciplines relevant to
breast cancer patients. In 2000, UT
Southwestern Medical Center, the
American Society of Breast Disease,
the Society of Surgical Oncology, and
the American Society of Breast Surgeons
collaborated to develop a standard
curriculum for Interdisciplinary
Breast Fellowship Programs. The Komen
Foundation began funding interdisciplinary
programs that use this
curriculum in 2001. At present, we
support 10 such programs at wellknown
medical institutions across the
United States.
Our efforts are helping to establish
and strengthen interdisciplinary breast
cancer care as the standard of excellence
in treatment. The model interdisciplinary
curriculum that was
subsequently developed with input from
the nation's leading breast cancer care
authorities includes opportunities for
physicians to appreciate the psychosocial
aspects of breast cancer in order to
better treat the whole patient.
The fear, doubt, confusion, and
hopelessness that emerge when patients
learn they have breast cancer will-in
the words of one renowned breast cancer
surgeon at UT Southwestern Medical
Center-never change. However,
well-designed interdisciplinary breast
care programs can help physicians develop
a deeper empathy with their breast
cancer patients through opportunities
to practice active listening skills, by
learning to answer difficult medical
questions clearly, and by "being there"
emotionally throughout treatment.
Conclusions
Dr. Rabinowitz points out that interdisciplinary
breast care programs
continue to evolve. We hope, along
with her, that they will also grow in
number, offering their many benefits
to more patients. In the coming years,
the superior interdisciplinary breast cancer
care programs likely will include:
- Integration of clinical trial experts on teams to educate patients and physicians about relevant trials,
- An increased role for researchers on teams, and inclusion of a stronger research component in training, and
- The use of new technologies to promote information sharing between urban-based centers and physicians serving medically underserved populations.
