‘A lot of pa­tients just hear breast can­cer’

The Irish Times - Tuesday - Health - - Health / Cancer - Anna Joyce

Pathol­o­gist Dr Marie Staunton has seen a dra­matic im­prove­ment in the field of symp­to­matic breast can­cer since she com­pleted her train­ing in 1999.

“When they [pa­tients] are given their prog­nos­tic in­for­ma­tion and when the sur­geon in­di­cates to them the type of breast can­cer they have and that they’re likely to have an ex­cel­lent out­come, they ac­tu­ally should be­lieve it. A lot of pa­tients just hear breast can­cer, and they just think of the most aw­ful out­come.”

Ac­cord­ing to Staunton, this trans­for­ma­tion is due in part to the ra­tio­nal­i­sa­tion of the can­cer ser­vices un­der the min­is­ter­ship of Mary Har­ney with Prof Tom Keane, who was then di­rec­tor of the na­tional can­cer con­trol pro­gramme. “Be­fore that, there wasn’t as much stan­dard­i­s­a­tion. And that has re­ally dra­mat­i­cally im­proved the ser­vice, at least from my per­spec­tive” she says.

Staunton de­scribes the treat­ment of pa­tients in Ire­land as “very much a team-driven process”, as com­plete col­lab­o­ra­tion is nec­es­sary to en­sure the best pos­si­ble treat­ment is pro­vided. “There has to be con­cor­dance be­tween the sur­gi­cal find­ings, the ra­di­ol­ogy find­ings, the pathol­ogy find­ings. We work in com­plete har­mony – there is great trust be­tween each other,” she says.

She neatly sum­marises this point with ref­er­ence to the “no-blame safety cul­ture” of the air­line in­dus­try.

“The pa­tient sees the sur­geon, and, in a way, the sur­geon is the most im­por­tant per­son. The pilot can fly the plane, but it is not much good if the main­te­nance crew have not put any wheels on the plane or there is no fuel. It is a col­lab­o­ra­tion be­tween ev­ery­body in­volved – you need all parts of it to work seam­lessly and with trust. We of­ten use analo­gies to the air­line in­dus­try be­cause in the air­line in­dus­try, air travel is so safe.

“If in­ci­dents oc­cur in the air­line in­dus­try, it’s not a cul­ture of blame, it is a cul­ture of ex­plain­ing what hap­pened so that peo­ple can learn from it in the fu­ture so within our sys­tem when some­thing oc­curs, we like to learn from each other in an open, non-threat­en­ing en­vi­ron­ment.”

Not one dis­ease

Staunton wishes more peo­ple un­der­stood that breast can­cer is not just one dis­ease. “It’s an um­brella term. And, within it, there are mul­ti­ple dis­eases which have very dif­fer­ent out­looks – al-

though from the pa­tient’s per­spec­tive, breast can­cer is con­sid­ered a sin­gle dis­ease process, it’s like a fam­ily of dis­eases, and within it, there are dif­fer­ent types of breast can­cer. Some of which are highly un­likely to kill a per­son and then oth­ers are ag­gres­sive and need ab­so­lutely ev­ery pos­si­ble avail­able treat­ment to max­imise the chances of the per­son hav­ing a good sur­vival. But it’s not one dis­ease – within it there’s a range of likely out­comes de­pend­ing on the sub­type. And that will be pri­mar­ily dic­tated by your pathol­o­gist.”

As part of rais­ing aware­ness (and funds) around the is­sue, Breast Can­cer Ire­land’s Avon­more Slim­line Milk-backed Great Pink Run takes place on Satur­day, Oc­to­ber 13th, in the Phoenix Park, Dublin, and on Sun­day, Oc­to­ber 14th, in Kilkenny Cas­tle Park.

As a pathol­o­gist, Staunton can spend hours a day look­ing down a mi­cro­scope and so by work­ing with the mul­ti­dis­ci­plinary team she is privy to “all of the real-life el­e­ments” of her work.

“I ac­tu­ally en­joy the in­ter­ac­tions with the multi-dis­ci­plinary team. I en­joy find­ing out about how peo­ple have done af­ter their di­ag­no­sis. We will hear the im­pli­ca­tions, we kind of feel in­volved in the pa­tient’s care and in the pa­tient’s jour­ney. We hear about whether they have chil­dren, what age they are, we’re very con­nected with the im­pli­ca­tions of a di­ag­no­sis of breast can­cer on pa­tients be­cause we hear the story sur­round­ing them.”

Sense of trust

Although the can­cer ser­vice has come un­der in­tense scru­tiny of late, Staunton feels it is cru­cial that a sense of trust in those de­liv­er­ing the ser­vice is main­tained. How­ever, she adds they need to be “cor­rectly trained in the be­gin­ning” and sup­ported in their pro­fes­sional de­vel­op­ment.

“We must have trust that we are trained prop­erly and that we are con­tin­u­ing to do things which are ev­i­dence-based and pro­to­col-based. Be­cause of the mon­i­tor­ing of our data year-in year-out, if there are any ad­verse trends, they will be spot­ted and we can in­ter­vene. That we can learn from what we’re do­ing well and the things we are not do­ing well, that we can im­prove the ser­vice from the in­for­ma­tion we glean from our au­dits and our mon­i­tor­ing of data, that we can use that to con­tinue to im­prove the ser­vice.

“I think the pub­lic needs to re­alise that it is not pos­si­ble to de­liver a blan­ket guar­an­tee that ev­ery­thing will be per­fect, but by mak­ing your sys­tem as safe as pos­si­ble, while you can­not guar­an­tee a per­fect out­come, you can give the best pos­si­ble out­come at that par­tic­u­lar point in time.”

Pathol­o­gist Dr Marie Staunton

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