Outpatient Mastectomy a Viable Option for Many Women
WebMD News Archive
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."
"Any hospital can do this," says Dooley. Citing nausea and vomiting
as the primary factors that incapacitate and distress women after the
procedure, he lists some general principles: less narcotics, more local
anesthesia, different sequencing of drugs, more education (before surgery to
reduce anxiety), support from local home care agencies, provisions with local
hotels for overnight stays (for those patients living one or more hours from
Lawrence Gratkins, MD, a pioneer in outpatient gynecologic surgery, points
out that his concern is insurance companies trying to decrease their
hospital-based costs and the cost shift to the physicians office and to the
patient. He tells WebMD that before we can make a national standard for
outpatient mastectomy, we must provide adequate education to nurses and
patients and families and community-based resources, like home health
providers. He is an obstetrician-gynecologist at Christie Clinic in Champaign,
Dooley says, "You have to constantly seek to improve your quality to
take a revolutionary step like this. What we found is that it holds us to a
higher quality standard. We tolerate glitches less."
Calling the Johns Hopkins report "very good clinical work," Michael
Torosian, MD, clinical director of breast surgery research at Fox Chase Cancer
Center in Philadelphia, tells WebMD, "It's a good technique for selected
patients ... young women who don't have any other medical problems and who
tolerate the anesthesia well.