Effect of surgical subspecialization on breast cancer outcome

Golledge, Jonathan; Wiggins, Joan E.; Callam, M J

doi:10.1046/j.1365-2168.2000.01534.x

Cited by 46 publications

(27 citation statements)

References 15 publications

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“…They analyzed patients between 1990-1992 and 1993-1996 before and after the advent of surgical subspecialization. After specialization, the disease-free survival improved from 70 to 79 %, and recurrence rates fell from 22 to 12 % at 3 years [17]. Similar results have been demonstrated before [18].…”

Section: Breast Cancer Outcomessupporting

confidence: 87%

A Review of the Effectiveness of Breast Surgical Oncology Fellowship Programs Utilizing Kirkpatrick’s Evaluation Model

Simpson

Scheer

2015

J Canc Educ

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It has been 10 years since the first class of Society of Surgical Oncology (SSO) fellowship trained Breast Surgical Oncologist entered practice. To date, there has been no publications examining the effectiveness of these training programs that are today throughout North America and Europe. This evaluative review examines the effectiveness of these fellowship training programs through the lens of the Kirkpatrick Evaluation Model. An extensive review of the literature was performed, and articles were categorized to capture how fellows are reacting to the program, what they are learning, and how the program is effecting their career path and impacting their patients. We can conclude that there is both direct and indirect evidence to support the effectiveness of this training program, but there is a paucity of direct evidence as one progresses from a level 1 Kirkpatrick analysis to a level 4. This review sets the framework for program evaluation in surgical fellowships and should encourage stakeholders to constantly evaluate the impact their program is having on trainees and oncology patients.

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Section: Breast Cancer Outcomessupporting

confidence: 87%

A Review of the Effectiveness of Breast Surgical Oncology Fellowship Programs Utilizing Kirkpatrick’s Evaluation Model

Simpson

Scheer

2015

J Canc Educ

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“…So konnten auch Golledge et al [16] eine Verbesserung der Überle-bensraten nach Einführung einer operativen Subspezialisierung für Mammakarzinomoperateure 1993 in Bedford, England nachweisen. Insgesamt wurden vor der Spezialisierung die Frauen von Ärzten gesehen, die 10-38 neue Fälle pro Jahr behandelten, danach wurde die Diagnostik und Therapie nur noch von Ärzten durchgeführt, die 65 bis 75 neue Mammakarzinompatientinnen pro Jahr sahen.…”

Section: Rolle Der Spezialisierung Des Operateursunclassified

Zertifizierte multidisziplinäre Brustzentren

et al. 2010

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Leitthema Das Mammakarzinom ist nach wie vor die häufigste maligne Tumor erkrankung der Frau. Nach Schät zungen des RobertKochInstituts er kranken in der Bundesrepublik jähr lich etwa 47.500 Frauen neu an Brust krebs [30], andere Quellen gehen von etwa 55.000 Neuerkrankungen aus [7, 13, 23]. Das mittlere Lebenszeit risiko beträgt in Deutschland 9,2%; es erkrankt somit durchschnittlich je de 11. Frau im Lauf ihres Lebens an Brustkrebs [30].Durch eine Reihe von Analysen gilt mittlerweile als gesichert, dass ei ne spezialisierte Teambildung und Zentralisierung in "Mammaschwer punkten" ("cancer units") zu einer Verbesserung der Therapie -und da mit des Outcome -des Mammakarzi noms führt, vorausgesetzt Qualitäts sicherung und management werden definiert und auch quantitativ über prüft (Benchmarking).

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“…Chemotherapy and hormone therapy have been repeatedly demonstrated to reduce the risk of local recurrence (EBCTCG, 1992) and improve survival in appropriate patients (EBCTCG, 1998;Aapro, 2001), although the overall use of chemotherapy during the study period was low. The information on local recurrence was not available in this study but there is evidence that specialisation reduces the risk of local recurrence due to increased use of systemic therapy (Golledge et al, 2000). The negative impact of chemotherapy in the multivariate analysis was most likely to have been due to the selection of the poorest prognosis individual patients for this treatment during the period in question.…”

mentioning

confidence: 75%

Surgeon workload and survival from breast cancer

et al. 2003

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The formation of multidisciplinary breast teams across the UK is intended to concentrate the assessment and treatment of breast cancer into the hands of high volume specialists. We undertook a retrospective population-based study in order to determine the trends in surgeon breast cancer workload in Yorkshire, UK, and to investigate whether patients treated by low-workload surgeons had poorer survival. Of 11 329 female breast cancer patients diagnosed in 1989 -1994 in Yorkshire, 6% were managed by surgeons with a mean annual workload of less than 10 new patients, while surgeons with workloads of 10 -29, 30 -49 and 450 treated 21, 21 and 52%, respectively. Over the study period, increasing number of patients were managed by surgeons with higher workloads. Patients treated by low-workload surgeons had poorer survival. Five-year survival was 60% in the lowest workload category compared to 68% in the highest category. The relative risk of death was increased by 15% (RR ¼ 1.15, 95% CI 1.03 -1.28) and by 10% (RR ¼ 1.10, 95% CI 1.02 -1.18) for patients managed by surgeons with workloads o10 and 10 -29 cases per annum in comparison to patients managed by surgeons with workloads of 450. The results of this study suggest increasing site specialisation in breast cancer among general surgeons. It also provides further evidence that the management of patients by surgeons with low workloads decreases overall survival.

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Effect of surgical subspecialization on breast cancer outcome

Abstract: There was a significant improvement in outcome for patients with breast cancer after surgical subspecialization in Bedford. This may relate to the more frequent use of appropriate systemic therapy.

Cited by 46 publications

References 15 publications

A Review of the Effectiveness of Breast Surgical Oncology Fellowship Programs Utilizing Kirkpatrick’s Evaluation Model

A Review of the Effectiveness of Breast Surgical Oncology Fellowship Programs Utilizing Kirkpatrick’s Evaluation Model

Zertifizierte multidisziplinäre Brustzentren

Surgeon workload and survival from breast cancer

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