The Susan G. Komen Breast
Cancer Foundation joins author
Dr. Barbara Rabinowitz in underscoring
the importance and value
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
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.