Dr Kristine Slam Discusses Preoperative Practices to Increase Treatment Value for Patients With Breast Cancer

Kristine Slam, MD, FACP, Central Ohio Surgical Associates, spoke at our recent Institute for Value-Based Medicine® event, held in partnership with the Zangmeister Cancer Center of Columbus, Ohio, on September 14. Here she discusses the positive impact that Choosing Wisely and enhanced recovery after surgery (EROS) protocols have had on patients receiving treatment for breast cancer.

Transcript

What measurable benefits have been observed from the shift to value-based care for breast cancer?

Two of the things that come most to my mind are the Choosing Wisely campaign and EROS protocols.

Choosing Wisely actually started back in 2012, and it was a bunch of societies coming together for mostly patient but also physician education about practices that have been routine for years that actually don't provide that much value to the patient. In the breast cancer world, this actually started by us surgeons not doing unnecessary axillary dissections [or] ordering unnecessary tumor markers. Now it has evolved into, again, ongoing education about not doing routine MRIs, not routinely doing sentinel lymph node biopsies in elderly or low-risk patients, not routinely reexcising lumpectomy close margins. So Choosing Wisely has, again, eliminated both short-term and long-term side effects for patients and financial toxicity.

The second thing that is helpful is something called EROS protocols, and these are specific to surgery. What the EROS protocols are designed for is limiting length of time in the hospital, limiting side effects, and it's through standardization of surgical practices. A lot of this involves preoperative education of patients, but it also is, again, very evidence based about things that work perioperatively to limit patient problems.