Surgeon Consultations for High Risk Cancer Patients to Continue at the Clinic
SUDBURY, ON – Health Sciences North is clarifying some misinformation that’s been circulating in the community the past few weeks regarding the Breast Screening Assessment Clinic of Health Sciences North (HSN), located at the Sudbury Outpatient Centre. In some cases, there were suggestions the future of this clinic was in limbo, or that the clinic was closing.
“HSN’s Breast Screening Assessment Clinic is not going anywhere. People have come to us for quality, timely, and reliable treatment in the past, and they will continue to do so in the future,” says Mark Hartman, HSN’s Vice-President, Cancer and Clinical Support. “I want to apologize for any confusion in the community on the future of breast screening in Sudbury.”
The clinic provides four types of service for patients. No changes have been contemplated for the first three types of service which are cancer screening mammography, diagnostic imaging (mammography and ultrasounds), and biopsies.
The one change HSN was looking at involved the fourth type of service where patients are directed to the next step of care, with a consultation with a surgeon. The province funds this fourth step through the surgeons’ private billing directly to OHIP, not through hospitals. As a result, HSN was proposing the location of the consultation with the surgeon be in the surgeon’s office as opposed to at HSN — as is the case for most types of cancer at HSN and as is the case for the other Northern Ontario hospitals. These appointments with surgeons at HSN are currently scheduled eight days per month and are being under-utilized. In 2017-2018, about half of the appointments with surgeons were rescheduled by the surgeons because of other commitments. This was not a good use of resources nor optimal for patients. The change that had been contemplated by HSN to this fourth step of care – namely the location of the consultation with the surgeons – had been validated by third party reviewers of HSN’s approved 2018-2019 budget and endorsed by the North East Local Health Integration Network.
However, following discussions with surgeons, HSN decided two weeks ago to adjust its original decision and schedule one day each week for surgical consultations for patients with diagnostic test results or referrals that are considered high suspicion of breast cancer. This approach will ensure high priority cases will have the fastest possible access to a one-on-one meeting with a surgeon. Patients with non-cancerous and benign conditions will have their follow up appointments after biopsy in the offices of the surgeons or their primary care providers.
“We understand that any potential change to the Breast Screening Assessment Clinic can alarm patients who were able to count on exceptional service from HSN staff and
surgeons”, observed Dominic Giroux, President and CEO of HSN. “The clinic is not closing. No changes were ever contemplated to three of the four services offered at the clinic.”
Dr. John Fenton, HSN’s Chief of Staff, concurs. “Today’s announcement means that patients considered as having a high suspicion of breast cancer will continue to be able to consult a surgeon at the clinic. We thank the patients who communicated to HSN their high satisfaction of the service received in the past.”
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Health Sciences North is improving the health of northerners by working with our partners to advance quality care, education, research and health promotion. HSN is grateful for the ongoing support of the community through the HSN Foundation, the Northern Cancer Foundation, the NEO Kids Foundation and the HSN Volunteer Association.
- The budget of HSN’s Breast Screening Assessment Clinic was $1.6 million in 2017-2018. Its 2018-2019 budget approved by the HSN board on April 12th was $1.5 million, evidence that the clinic was never closing.
- HSN follows Cancer Care Ontario guidelines for breast cancer care. HSN currently meets or exceeds all provincial breast diagnostic assessment guidelines.
- HSN’s turnaround time between abnormal screening mammogram to diagnosis is better than the provincial target and will continue to provide timely pathology results to minimize wait times.
- Members of medical staff are not hospital employees. It is their responsibility to hire the appropriate staff to serve their patients as part of their private practice. This expectation was reinforced by third party reviewers of HSN’s approved budget.
- Patient visits for follow up of non-cancerous results and low risk of cancer after mammography represents approximately half of current visits at HSN’s clinic. By focusing surgical consultations on cancer diagnosis and patients at high risk of cancer diagnosis, HSN expects to improve wait times for surgical consultation from the current 18-day average to at least the provincial average of 10 days. This approach exceeds what is provided at most other hospitals in Ontario.
- Core biopsies will continue to be provided at the clinic as part of the diagnostic process.
- Medical students will continue to be able to participate in the weekly surgical consultations at the clinic.
- HSN’s clinic accommodates 2,000 ‘visits’ per year (not 2,000 patients as some patients have multiple visits). By focusing on cancer and high risk of cancer, assessment patients will be directed to the most appropriate setting for care.
- HSN’s clinic will continue to be staffed by highly skilled nurses, including a part-time nurse navigator to ensure that patients are seen in a timely way.
- HSN will continue to monitor the time from referral to consultation for cancer patients. This is an important indicator also monitored by Cancer Care Ontario. In the past 12 months, 92% of cancer patients at HSN have waited less than the provincial target of seven weeks from abnormal screen to diagnosis. This exceeds the provincial target of 90% within this time period. This will continue.
- The screening, diagnostic imaging and surgical consultation components of the clinic were brought together in 2010. Prior to this time, they were in separate locations. The purpose was to expedite the time from suspicious screening mammogram to cancer diagnosis. This will continue as originally intended. The clinic was never intended to provide a surgical consultation service for benign disease. Most other hospitals that operate breast diagnostic assessment programs do not include benign or low risk visits.
- HSN does not expect that the changes in the service will impact wait times. In fact, wait times had been declining over the last two quarters due to physician availability. Therefore, with better coordination of physician schedules, HSN expects the wait times to improve.