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AS I SEE IT


Breast Cancer Surgery in the ASC Setting Arkansas surgery center helps pioneer innovative technique BY MICHAEL J. CROSS, MD, AND DAWN ASHBY, RN, CASC


ASCs today are adapting to mul- tiple shifts in the health care and financial envi-


ronments. Among the many challenges they face as this evolution continues are changing reimbursement, more knowl- edgeable patients who evaluate


their


health care options with that knowledge in hand and increased competition from hospitals that purchase physician practices. Our North Hills Surgery Center


in Fayetteville, Arkansas, faces many of these challenges, but innovative approaches to both infrastructure and clinical care have helped us to remain viable and continue to serve our com- munity. One of the clinical care inno- vations that we have adopted is our approach to breast cancer treatment. Our surgery center was cofounded


by physicians and the local Washing- ton Regional Medical Center, and is jointly owned by both. Washington Regional recognizes that there are some modalities of care that can be better provided by an ASC. And, of course, the surgical center and our approximately 30 physicians know very well that some cases are best handled at the hospital. This collabor- ative relationship allows us to pick the best place to deliver care while pro- viding more options to our patients.


Breast Cancer Treatment at Our ASC Many women with breast cancer have their surgery in a hospital setting. For cases of lumpectomy, however, it is possible and, for patients without comorbidities, often preferable to do the surgeries in an ASC.


12 ASC FOCUS MAY 2016


ASCs have a pivotal role to play in expanding the availability of innovative, high-quality breast cancer care.”


— Michael J. Cross, MD, School of Oncoplastic Surgery, and Dawn Ashby, RN, CASC, North Hills Surgery Center


Lumpectomies fit well within an ASC setting because they generally involve just one or two incisions, mini- mal blood loss, no drains and a lower risk of anesthesia complications than more complicated surgeries. The rela- tively quick turnaround time of the ASC setting allows a surgeon to do multiple lumpectomies on a given day, if needed. The lumpectomy-versus-mastec-


tomy discussion, of course, has been spirited in recent years. An important part of the treating surgeon’s job is to discuss breast cancer patients’ various options and to respect the choices that informed patients make. Some patients with early-stage breast cancer opt for a mastectomy even though their cancer is readily treatable with a lumpectomy.


Some even seek a double mastectomy when there is no contralateral cancer. In fact, mastectomy rates have increased 34 percent in the US between 1998 and 2011, according to a recent study pub- lished in the Journal of the American Medical Association (JAMA) Surgery. At the same time, two new stud-


ies presented at the 2015 San Antonio Breast Cancer Symposium together concluded that for early-stage breast cancer, lumpectomy-plus-radiation on average has better overall outcomes than mastectomy plus reconstruc- tion. Moreover, the studies found that lumpectomy-plus radiation has fewer complications and is less expensive. While traditional breast-conserving lumpectomies provide excellent cancer


The advice and opinions expressed in this column are those of the authors and do not represent official Ambulatory Surgery Center Association policy or opinion.


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