The four-year Saskatchewan Surgical Initiative (SSI) aims to cut surgery wait times by three months by 2014. Its goal is to improve your experience if you are a surgical patient.
To do so, it assembled health professionals (and even patients) from across the province to tackle statistics that showed surgery rates vary widely—and to look into why. How much was appropriateness a factor? Were there fluctuations in quality of care?
The SSI had its own provincial health statistics to analyze. And last fall, CIHI’s breast cancer surgery report added some additional revealing statistics to the mix. Produced in collaboration with the Canadian Partnership Against Cancer (CPAC), this report examined the rates of mastectomy versus breast-conserving surgery (aka lumpectomy), of re-excisions and of other surgical procedures and complications. It uncovered wide variations in breast cancer surgery across the nation.
Dr. Peter Barrett, physician leader at the SSI, said they set up a mastectomy working group soon after the report was released to focus exclusively on CIHI’s data. He said that the significant variation shown in the CIHI-CPAC report, when unexplained, implied a quality-of-care issue. “We’ve been very interested in that in Saskatchewan,” said Dr. Barrett, a former CIHI Board member.
This is what the working group was most interested in: a crude mastectomy rate in Saskatchewan of 65%, second only to Newfoundland and Labrador’s 69% as the highest in Canada. (The mastectomy rate varied greatly across Canada, dropping to 26% in Quebec.) Also on the agenda: variations across regions and facilities.
This group assembled breast surgeons from across the province, keen to be involved and find answers. Initial explanations touched on findings from the report, which included the fact that travel distance to a surgical centre could impact a patient’s treatment decisions. But there was one problem with that explanation: next-door neighbour Manitoba’s crude mastectomy rate was a much-different 36%.
“How do I explain Saskatchewan being the second highest and Manitoba being much lower, provinces that sit adjacent to one another with the same geography?” Dr. Barrett asked. With no clear explanations, they began seeking answers.
And it’s an ongoing pursuit. To find out why cancer patients choose certain approaches—driven in part by the CIHI-CPAC report—a University of Saskatchewan study is under way. This summer, patient interviews will begin to help uncover what influences patient choices for mastectomy and breast-conserving surgery.
“It will be fascinating to see why patients choose a certain approach to treating breast cancer,” Dr. Barrett said. “There may be a whole pile of reasons we had never considered.”
Dr. Barrett said that, in the near future, data is “going to be everything.” An accomplished surgeon, he suggested that the system must move away from simply funding more surgical procedures and striving to trim waiting lists.
“We aren’t spending enough time looking into patient-reported outcome measures,” he said. “That’s when you’ll really get into shared decision-making. It helps show patients ‘Here is what you are likely to get out of this treatment, and here is what you will likely go through to get it.’”
That would certainly be top of mind for breast cancer patients debating life-changing choices about treatment options. As the report shows, there is anything but a uniform approach in Canada in this regard.
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