Outpatient Mastectomy a Viable Option for Many Women
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 Dooley.
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 the hospital).
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, Ill.
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.