Outpatient Mastectomy a Viable Option for Many Women
March 24, 2000 (Atlanta) -- It was the summer of '96 when Carol Stacey got
the news. Breast cancer. Her feelings were "absolute terror," Stacey
tells WebMD. Mastectomy, or complete removal of the breast, was necessary, but
her surgeon offered outpatient surgery as an option, which meant, in this case,
less general anesthesia, less nausea -- and no overnight hospital stay.
"Even then, I expected to feel terrible, like you do after most
operations," says Stacey. "But when I went home, I felt great, great!
That very same day. You're usually nauseous, drugged, for a couple of days. But
I felt good, really good."
Later, a few HMOs tried to make the outpatient procedure mandatory, and it
was branded by some as "drive-through mastectomy." Battles were fought
in state legislatures to ban the procedure. Surgeons from Johns Hopkins Medical
School found themselves lobbying for patients' rights. Stacey found herself
compelled to write a letter to the Baltimore Sun, a testimonial about
her own very positive experience "so that women would have the option at
least of having this as outpatient surgery," she tells WebMD.
Unfortunately, in the media uproar, some very promising data got lost,
William Dooley, MD, a surgical oncologist and medical director of Johns Hopkins
Breast Center, tells WebMD. At Hopkins and a handful of other top cancer
treatment hospitals, outpatient mastectomy was proving to be a significantly
better option for some women.
"The HMOs had found that patient outcomes [at these hospitals] were
substantially better and with less risk," says Dooley, who helped lead the
lobbying effort in Maryland and on Capitol Hill. "Each of these hospitals
[surveyed by the HMOs] had gone about it like we had, improving quality of
care, which made it possible for patients to go home early."
"Outpatient mastectomy is both medically safe and can be a positive
treatment experience if patients and families are well prepared," Dooley
reported at a recent meeting at the Society of Surgical Oncology.
He presented data on a series of mastectomies in 204 patients, average age
58, all performed between 1995 and 1997. All patients were given the option of
having the procedure done on an outpatient basis -- meaning they would leave
the hospital five hours after surgery.
One year beyond active breast cancer treatment, surveys revealed a very good
or excellent satisfaction score in 98% of patient cases. "The most commonly
cited reason for high satisfaction was the empowerment felt by the patient and
family to participate in the decision-making and treatment processes," says
Since 1995, when the outpatient program began, patient choice grew from a
low of 15% to 80% in 1997. Currently, 95% of patients choose to be outpatients.
Also, says Dooley, "The majority of women who chose to do it as outpatients
also had fewer side effects and complications through their chemotherapy and
radiation therapy. So the positive psychological benefit ... seemed to have
some lingering effects."