What top quality means for a patient
Katie, a buyer at a major high street retailer, was diagnosed with breast cancer when she was 34.
Breast cancer in young women is a challenge for any cancer care system. It is thought of as rare, but is actually surprisingly common (more life-years are lost to breast cancer in women under 50 than over 50). The tumours tend be aggressive and require vigorous treatments that can cause infertility. It is not always detected early because of low levels of awareness and because it is more difficult to identify lesions in young people with higher breast density. At HCA, young women are often seen following late diagnosis or inappropriate treatment elsewhere. Unfortunately, in many of these cases a cure is unlikely and HCA must instead focus on fighting for extra time.
Treating young women’s breast cancer effectively requires a cancer system to operate at the highest levels of excellence, as HCA’s network did for Katie.
Discovering a lump
Katie’s diligence and attention to detail had always been a great asset in her career as a young buyer at a major high street retailer. At 34, her talent for picking next year’s hot product and working tirelessly with suppliers to secure it meant she had a bright future. When she discovered a lump in her breast one morning, she immediately made an appointment to see her GP.
At the GP surgery, Katie was lucky: her doctor had recently attended a symposium by HCA’s breast cancer service on the issues surrounding young person’s breast cancer. Held at the Royal Institute of Great Britain, it brought together experts from across the world to debate the latest techniques to diagnose and treat the disease. After a quick examination, her GP referred her to HCA’s unit at the Princess Grace Hospital, which has a strong reputation for breast cancer diagnostics in young women.
Katie’s first appointment was with an expert in breast cancer diagnosis with a recognised reputation for research into young women’s breast cancer. Following her examination and tests, he was able to study a unique set of high- quality images: a digital mammogram and a breast MRI scan. The breast MRI was especially important, as it is more effective for denser, younger tissue. For Katie the news was deeply unsettling: the lump was suspicious, so a biopsy was required to confirm whether or not it was a cancer. Katie left in a state bewildered anxiety. Despite the best efforts of the staff at the clinic, no amount of explanatory discussion or comfort would help. Her only comfort was that she knew she would have a rapid result and she had the number of her ‘Patient Navigator’ Amy, to call at any time if she had questions. Katie and her partner John spent an agonising evening trying not to worry but ultimately failing.
Unbeknown to Katie, the HCA breast cancer network was rapidly swinging into action. Her biopsy was in the HCA lab by the next morning to be examined by a leading pathologist. HCA’s advanced molecular diagnostic lab was also hard at work analysing the genetic structure of the tumour to ensure the treatment team would be armed with the most potent, advanced treatments. Katie was surprised to get a call that day asking her to return to the clinic to discuss her results. The NHS breast screening programme aims to send out results within two weeks, so Katie was relieved that she would have a definitive answer so quickly.
When Katie revisited the clinic, it was to receive bad news. HCA’s cancer network has invested significant time and effort to ensure that bad news is broken in the most sympathetic, appropriate way, and Katie’s experience reflected how this pays off for patients. She was given immediate access to the appointment without getting caught up with other patients, the consultation was conducted in a supportive and informal environment, and she had full access to the key information.
The process went as well as could be expected, but Katie still needed to sit with Amy (her ‘Patient Navigator’, who was present throughout) for some time before she could fully take the results on-board.
It was clear that a broad range of treatment options were available at HCA, including clinical trials. Katie felt overwhelmed as the pros and cons of each were explained; she was disturbed to hear that she might also need to consider fertility services. Luckily if it came to this, HCA operated the UK’s largest private IVF unit, so Katie could access this quickly and seamlessly.
As ‘treatment planning’ proceeded, Katie was surprised and re-assured to find her case would be reviewed in a prospective Multi-Disciplinary Meeting (MDM). Unique in the private sector, this is where the whole treatment team, including multiple consultants, comes together to discuss her case and develop a treatment plan. Katie drew on Amy’s experience and expertise heavily during this period. She took her time to assess the treatment options, before agreeing the plan with the treatment team. Amy also introduced Katie to Maggie’s, a charity focused on providing support to people affected by cancer, who were a big help.
Katie went ahead with surgery to remove the cancer, followed by chemotherapy which would ensure that no cancer remained. Rather than removing the whole breast, Katie would have breast conserving surgery where only the part of the breast around the cancer is removed. Katie was relieved that she would not lose her whole breast as this would feel like a loss of femininity. Before the surgery, Amy also showed Katie some pictures of the surgeon’s previous results, which showed he was clearly highly skilled. Knowing what to expect aesthetically also removed some of Katie’s uncertainty.
For her chemotherapy treatment, Katie’s treatment transferred seamlessly to Leaders in Oncology Care (LOC) on Harley Street. Katie’s treatment plan required her to attend the clinic every week for 6 weeks for a lengthy treatment appointment. Luckily for Katie, the LOC prides itself on delivering a first-class patient experience. Given how much time she spent there, Katie was pleased with this and that the environment was comfortable and non-clinical.
Living Well Programme
Once Katie’s cancer was defeated, the benefits of the Living Well programme, a first-of-its-kind foundation set-up by HCA, became clear. Many patients can feel abandoned and forgotten once treatment is finished. The cancer is cured, but this does not mean the patient is well. The Living Well programme recognises this and helped Katie to get over the psychological issues which had arisen during her cancer experience. Through counselling sessions and workshops with other cancer patients, Katie was able to move past the emotional roller-coaster and move forward with life, work and her relationship with John.
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