Breast Cancer Quality Measures - Assignment Example

? Assignment 3 Overview of the Issue With the increasing rate of incidence of deaths caused by breast cancer around the globe, it has become vital for every nation to implement new strategies and policies to overcome the issue in the healthcare sector more efficiently. Singapore, an island country, which is often considered to be a practitioner of an effective and globally recognized healthcare system, has also been deciphering concerns on the rising incidence rates of breast cancer in the global platform. In order to provide a convenient healthcare system within the country, the Singaporean government has considerably extended their line of hospitals in the dimensions facing higher risks of breast cancer. It is estimated that the rate of newly diagnosed breast cancer amid women plunged massively from 21.5 per 100,000 females in 1971-1975 to 60.7 per 100,000 females in 2006-2010 (National Registry of Diseases Office, 2012). Considering the increasing rate of breast cancer as an alarming healthcare issue, the government of Singapore has set up a Breast Screen Singapore (BSS) program, which is considered to be the first population based mammographic breast screen program in Asia adapting international standards and guidelines. It is also worth mentioning that for improved quality assurance, two-view screening mammography is being promoted within the Singaporean healthcare sector in accordance with international standards and guidelines. Additionally, the government has also made it compulsory for every health care institute and medical practitioner to notify each cancer case through electronic notification or hard copy to the government under the National Registry of Disease Act that will help in maintaining a continuous check regarding the expansion of the issue (National Registry of Diseases Office, 2008). On close observation, it was found that colorectal cancer has the highest percentage in comparison to other forms of cancer amid females in Singapore. However, statistical measurement done in the years 2008-2012 shows that breast cancer still remains a major problem and is considered to be a major cause of the frequent deaths in Singapore recorded for these years (National Cancer Centre of Singapore Pte Ltd., 2012). Singapore is considered to be a country known for its healthcare policies to maintain a stable incidence rate of deaths and have a healthy society flourishing. Following the applied trend of expanding the line of maternal and childcare hospitals, the Ministry of Singapore also formulated a national cancer management plan for treating cancer patients as it was measured that cancer is the most common cause behind the increasing death of people within the country. Among the various forms of cancer, breast cancer among women was observed as the most common, based on the estimation of cancer registration that started in the year 1968 in Singapore. It has also been estimated that the number of cancer patients will rise by 5% until 2015 (Wong, 2012). Henceforth, the discussion will aim to report on the increasing issue of breast cancer in Singapore, mainly concentrating on the remedial approaches that the government needs to implement. Correspondingly, few noteworthy recommendations will be provided through this report along with a budgetary planning to make efficient use of the resources allotted for this purpose. Justification of need Healthcare system in Singapore is considered to be amongst the best within the worldwide context. In 2000, the World Health Organization (WHO) has ranked Singapore healthcare as the sixth best overall healthcare system out of 191 countries worldwide. Irrespective of its competencies and advancements, cancer is considered to be the prime reason of death in the country. The most common cancer that exists within the country is lungs cancer in men and breast cancer in women. To be specific, breast cancer is considered to be the most common cancer among the females of Singapore especially women aging more than 50 over the last 30 years. Estimations and past records show that the age incidence rate has almost increased thrice from 20.0 to 60.9 per year (estimated amid 100,000 female), which although considerably low in comparison to the western countries, signify deep concern regarding the health of the women populaces in Singapore (Wong, 2012). The issue should be considered as equally serious as any other forms of cancer, owing to the fact that women suffering from the disease often decide to maintain secrecy regarding their health problems and thus, overlook the issue which in turn causes death. Additionally, ill-health of women populaces may signify a deteriorated health of the overall population in the long run. According to the recent report published by the Singapore Registry data, the age in which risks for breast cancer seems to be extreme, has risen from 45-49 years to 50-55 years, which suggest that the breast cancer viewed in Singaporean women is shifting more in a pattern usually viewed in the western countries (Wang, 2003). The increasing breast cancer incidences and the positive results from Singapore Breast Screening Experimental plan, both signify the need for addressing the issue with greater concern. Understanding its severity, the government launched the BSS program that intended to fund breast screening program using dual mammography to detect the disease, especially targeting the age groups above 50 years old as it is this particular group showing increasing propensity of breast cancers. The government also adapted various strategies like conducting public education and also telecasted various programmers to spread awareness relating to breast cancer within Singapore. Additionally, campaigns were conducted in various rural areas of Singapore to educate the civilians about the importance of BSS. The mammography service that the government launched is further applied in a manner connected to a centralized reading and assessment managed by the Health Promotion Board (HPB) directly (Wang, Tan & Chow, 2011; Wang, 2003). The issue relating to breast cancer amidst the female populaces in Singapore has been witnessed to be growing continually, resulting in the introduction of the BSS in the year 2001. Although it was launched for a commendable purpose and to increase the overall efficiency of the healthcare system in Singapore to combat cancer problems, it also possesses the limitations of complexities to a great extent. Under this policy, the patients need to co-pay at each step of the screening making the procedure more complex and time consuming. The program has been formed adapting international standards; however, lack of adequate manpower within the healthcare sector of Singapore has been causing a major issue by barricading the effective functioning of the healthcare program. It has also been measured that there was an increase of 37% inpatient in National University Cancer Institute amidst 2008-2011 in the oncology rate directly indicating a rise in the number of cancer patients, a proportionate of which was further diagnosed with breast cancer (Wong, 2012). 7,781 new cases of breast cancer were also diagnosed from 2006-2010, which is considered to be a considerable figure, indicating to the success of BSS in identifying the true rate of incidence of breast cancer and its high potentiality to remain uncovered owing to lack of awareness and reluctance amid general people. Increase at such huge proportion might raise difficulties for the government body to deal with the issue effectively, in terms of proper allocation of resources. On analysis of the estimated data by Singapore Registry, it was observed that the median age at diagnosis of breast cancer among the female populaces was 53 years, thus making 50 years as the age for routine screening (Government of Singapore, 2013). In this context it can be stated that maintaining effective data of such a huge number can be regarded as another problem, which supports the need of establishing a secondary policy framework that would help in mitigating the arising issue and at the same time, help in maintaining the data efficiently for future use working in alliance with BSS (National Registry of Diseases Office, 2012). Figure: Age-specific incidence rate by stage for the year 2006-2010 (National Registry of Diseases Office, 2012) As can be observed from the above diagram, the stage I and stage II cancer chronicity can be observed as high among populaces belonging to the age-group of 30-49 years. However, although the chronicity does not rise substantially within the age group of 50-59 years, it shows considerable decline among the age-group of 60-80+ years. Again, the above graph represents that women ageing between 50-80+ years have increasing risk of Stage III and Stage IV cancer types, which require adequate amount of care to be taken for the middle and older aged women, in comparison to younger women populaces supporting the need of additional healthcare services in mitigating the issue of breast cancer. Again, according to the estimation made by the National Registry of Diseases Office, women patients suffering from breast cancer deciphered a survival rate increase from 34.9% in 1973 to 67.9% by 2007, resulting from early detection of cancer treatment. Therefore, if additional healthcare policies are established, the large number of lives can be saved by early treatments resulting in decreasing rate of deaths by cancer (National Registry of Diseases Office, 2012). There exist numerous factors that may result in increasing risks for women suffering from breast cancer like early onset of menstruation, having the first child after the age of 30 years, hormone replacement treatments and sedentary lifestyle among others. Therefore, it is very crucial that adequate steps are taken by the government t in mitigating the rising issue of breast cancer within the country, which also supports the need of creating an extended healthcare unit specialized in breast cancer in Singapore. Additionally, the women aging between 50-69 years should be motivated to go for screening mammograms after every two years being adequately informed regarding the risks and benefits of mammograms (National Registry of Diseases Office, 2012). It is also worth mentioning that 51% of the females, per 100,000 in Singapore have a chance of being affected with the disease every year. Apparently, this can be signified as a challenge in maintaining a healthy demography (Government of Singapore, 2013). Proposed Recommendations for Intervention Risk Factor Identified Research has lifted veil from many risk factors that has resulted in the formation of abnormal cells resulting in causing breast cancer. By identifying the risk factors one can find the root cause of the disease and henceforth operate in reducing the incidence rate of deaths caused by the health problem. Although, adequate research has been conducted to identify the root cause of breast cancer in Singapore, 50% of the patients have been recorded with no identifiable risks, which make the issue more serious. According to Singapore Registry data, the trend of breast cancer in Singapore is estimated to grow with the increasing age of an individual. It is almost uncommon in women aging below 40 years. However, it has been viewed that the growth of abnormal cells within a female body starts from the age of 30 years and thus, can be affirmed to remain in non-invasive phase until the age of 40-50 years. It is worth mentioning that the government has made it compulsory for women to undergo mammography after 40 years to control the increasing rate of breast cancer within Singaporean women. In this context, it can be stated that if the rule is modified to the age of 30 years, early detection of cancer can help in decreasing the rate of people suffering from Breast Cancer in the country (National Registry of Diseases Office, 2012; Singapore Cancer Society, 2013). Figure: Age-specific Incidence rate of Breast Cancer among different age section from 2006-2010 (National Registry of Diseases Office, 2012) It has often been viewed that a woman has a higher degree of breast cancer if her mother or other blood line relatives have been affected with the disease, i.e. the tendency being genetically transmitted. However, in modern context, family history is not regarded as a significant risk factor as it has been viewed that among the entire population of breast cancer patients, only 10% of their relatives did have the same disease (Singapore Cancer Society, 2013; Health Promotion Board, 2012). In this context, the government can create a data base that would store the health conditions of every female born in the country since her childhood. In this way, the government can track down the actual percentage of the total women being affected by the disease owing to genetic reasons and would also be able to develop alternative course of actions accordingly to mitigate the issue from roots. Certain factors of a woman reproductive history may also increase her risk of being affected with cancer. Some of the identified risks are stated here under. Women having their first child after 35 years old Early onset of menses Late cessation of menses In this context, the government should adapt new strategies to suppress the secretion of oestrogen, which is one of the prime female hormones associated with the reproductive system (Singapore Cancer Society, 2013; Health Promotion Board, 2012). Diet is considered to be another vital factor that increases the chances of being affected with breast cancer among females. Eating too much red meat and fats and minimum fiber contained food items may increase the probabilities of cancer in a woman. The National Institute of Health And American Cancer Society has thus suggested women to consume less than 20% fat daily and increase intake of fiber foods such as fruits and vegetables (Singapore Cancer Society, 2013; Health Promotion Board, 2012). Notably, such changes in the lifestyle practices of the population can only be instigated with an increase in the awareness amid the local community. In this respect, the government can set up different bodies to spread awareness regarding food habits among the female populaces that can increase the chances of being affected by the disease. Additionally, the government can also expand a new line of cancer treatment units throughout its healthcare system so as to expand its reach to the most rural parts of the country, diagnose the actual causes of the problem and take requisite measures to mitigate the same. Best Practice & Cost Effectiveness Additionally, the currently applied BSS program and its adapted policies also possess certain limitations in identifying the root causes of breast cancer and taking required remedial measures. For instance, the program uses mammography, which is the other name of the X-Ray technology, in order to find out if there is a growth of abnormal cell within the breast. However, over the years, it has been criticized for being a painful process and has a certain degree of risk from radiation exposure. It has also been studied that no mammographic test rewards 100% accurate results, which limits its progress in identifying breast cancer. This raises the risk of wrong medical treatments, wherein many cases have shown abnormal results resulting in further requirements of costlier surgical tests to detect if there is an abnormal growth of cells. In this context, adaption of digital tomosynthesis would be more effective as suggested in the new healthcare approach. It is generally a process of performing high-resolution tomography adapting the same dose level as used in mammography tests. Additionally, a study conducted to find out the cost difference amid mammography and tomosynthesis showed that a saving of $10,185 per 1000 woman is possible for those who adapted tomosynthesis process of screening (Singapore Cancer Society, 2013; Kalra, Haas, Forman & Philpotts, 2012). Thus, it can be stated that replacing mammography with tomosynthesis would be more effective to deal with the issue of rising breast cancer incidence rates. Additionally, it is considered that early detection of breast cancer can help in saving the life of the patients. Therefore, in this context if proper steps like conduction of campaigns in rural areas to inform the locales regarding the various methods that can help them to detect breast cancer and take precautionary measures, can be conducted. Introduction of special classes within schools, especially targeting the female students along with diet charts to the children may prove beneficial in developing a better health consciousness among them and mitigate the risk of breast cancer at the root. Additionally subsidiary of government bodies in different regions of the country can also help in decreasing the death rate resulting from breast cancer to a great extent, by using the aforementioned techniques of awareness generation (WHO, 2013; Centracare Health, n.d.). Draft budget Particulars Costs Research and process planning $5,000 Replacement of traditional technologies with advanced technologies $30,000 Organising meetings with the intended stakeholders $10,000 Promotional campaigns $10,000 Training professionals $25,000 Awareness campaigns $10,000 Recording and assesing the outcomes as per the measuring criteria $10,000 Figure: Draft Budget With items along with the total cost of each item Individual stakeholders The different stakeholders that would be associated for developing the above suggested new healthcare approach and also support the proper implementation of the plan will include the government, professionals, employers of the Singapore healthcare sector, and other development partners. It is worth mentioning in this context that Government will play a prior role in the facilitation, prompting and execution of the new healthcare plan implemented in public interest to reduce mortality rates caused by breast cancer. In this suggested plan, the government shall be responsible to allot the budget required along with taking adequate policy measures in accomplishing the goal determined under the proposed new healthcare policy. Correspondingly, as professionals will be the sole responsible group to implement the approach with efficiency, they are also required to be trained and informed adequately to understand the significance as well as requirements of the new healthcare approach. Nevertheless, employers of the healthcare sector will be responsible to train and manage the workforce of efficient workers in delivering the planned healthcare services to the women of the society in order to reduce their risk exposure rate to breast cancer. Additionally the top level management must ensure that the employee takes active participation in the decisions taken by the body to ensure greater effectiveness of the plan. Last but not the least; the development partners can be considered to be a helping hand in making the plan more effective. In this context it is very essential that the partners take effective steps to evaluate the major criteria that need to be covered before execution of the final plan. It is worth mentioning that the development partners involved in this approach will be responsible to study all the costs and the economic support before deciding the final plan is executed to yield utmost efficiency (WHO, 2013). Evaluation The importance of outcome assessment is considered to be a vital aspect in today’s healthcare context. Evaluation and improvement method is very vital in cancer treatment as it helps in improving the quality of cancer care and likewise, reduces cancer related health differences. In this regard, the association must evaluate existing measures and develop alternative strategies for a valid and reliable patient-centered measure. Correspondingly, the different methods to be embraced by the association to incorporate specific ‘health outcome measures’, under the proposed new approach are as follows. 1. Recording the number of individuals informed about breast cancer risks: To be noted, as proposed in the new healthcare approach, young females as well as women of other age groups are to be informed about the growing risk of health problems. Hence, with the increase in the recorded data concerning the number of individuals acknowledged about breast cancer, it can be inferred that the approach is yielding the expected health outcomes. 2. Change in the food habits and lifestyle among women populaces: With the increasing awareness, it is expected that the female populaces will develop better understanding and consciousness about health problems that may further increase the risk of breast cancer and accordingly change their food habits as well as lifestyle choices. Hence, this will also mark the attainment of the expected health outcomes through the research. 3. Increasing rate of non-invasive breast cancer being diagnosed: With the growing awareness and more advanced technology support, making accurate judgments regarding breast cancer incidents would be possible. Correspondingly, medical practitioners shall be able to deliver better care and concern to those patients and reduce mortality rates caused by breast cancer problems. 4. Reduced rate of breast cancer incidence: The most vital measure would be the reduction in the death rate caused due to breast cancer every year in Singapore. The proposed new healthcare approach fundamentally aims to generate better awareness regarding the health issue amid Singaporean women in association with the BSS program. Likewise, it intends to form a body that would help in ensuring that the schools and colleges provide basic knowledge of the different conditions that can result in formation of breast cancer among young females. Areas that have a large influence of breast cancer can be considered on a priority basis, under this new approach organizing special campaigns to teach them the various diet plans that would help them to be safe. The association should also introduce free classes in different institutes to the advantage of physical exercise. In this context, surveys can be conducted to find out the effectiveness of the proposed plan in the rural areas. Advertisement in television and other social networking sites can also help in spreading awareness of the growing disease in Singapore. The government can also set boxes in different parts of the country, where results of the proposed plan would be collected with greater accuracy. Additionally, maintaining a database of the patients who have suffered from the disease in the past can also help in evaluating the outcomes of the proposed plan (US Department of Health & Human Services, n.d.). References Centracare Health. (n.d.). Breast cancer quality measures. Retrieved from http://www.centracare.com/services/cancer/quality-measures/breast-cancer/ Government of Singapore. (2013). Population and population structure. Retrieved from http://www.singstat.gov.sg/statistics/browse_by_theme/population.html Health Promotion Board. (2012). Breast cancer. Retrieved from http://www.hpb.gov.sg/HOPPortal/dandc-article/778 Kalra, V., Haas, B., Forman, H., & Philpotts, L. (2012). Cost-Effectiveness of digital breast tomosynthesis. Retrieved from http://www.hologic.com/data/Medical%20Professionals/pdf/Kalra-Summary-RSNA.pdf National Registry of Diseases Office. (2012). Trends of Female Breast Cancer in Singapore 2006-2010. Health Factsheet. 12(3), pp. 1-9. National Cancer Centre of Singapore Pte Ltd. (2012). Cancer statistics. Retrieved from http://www.nccs.com.sg/patientcare/whatiscancer/cancerStatistics/Pages/Home.aspx National Registry of Diseases Office. (2008). Cancer registry notification. Retrieved from http://www.nrdo.gov.sg/page.aspx?id=64 Singapore Cancer Society. (2013). Breast screening. Retrieved from http://www.singaporecancersociety.org.sg/lac-fcb-breast-screening.shtml Singapore Cancer Society. (2013). Breast cancer. Retrieved from http://www.singaporecancersociety.org.sg/lac-fcb-what-is-breast-cancer.shtml US Department of Health & Human Services. (n.d.). Cancer outcomes measurement working group. Retrieved from http://appliedresearch.cancer.gov/areas/assessment/comwg.html WHO, 2013. Providing for health. Retrieved from http://www.who.int/providingforhealth/topics/stakeholders_p4h/en/ WHO. (2013). Breast cancer: prevention and control. Retrieved from http://www.who.int/cancer/detection/breastcancer/en/index3.html Wong, J. E.L. (2012). NCIS oncology updates for general internal and family medicine. Retrieved from http://www.nuh.com.sg/wbn/slot/news/ah01/62ec80c2b_u6272.pdf Wang, W. V., Tan, S. M. & Chow, W. L. (2011). The Impact of Mammographic Breast Cancer Screening in Singapore: A Comparison Between Screen-detected and Symptomatic Women. Asian Pacific Journal of Cancer Prevention. 12, pp. 2735-2740. Wang, S.C. (2003). The Singapore National Breast Screening Programme: principles and implementation. Ann Acad Med Singapore. 32(4), pp. 466-76. Read More