Barbara Abrams had worked as a labor and delivery nurse since 1979 and planned to retire last year. It just so happened that the day she had selected to bow out ended up being the day her granddaughter was born.
But following this newfound joy in her life came some bad news: Abrams was diagnosed with cancer in her left breast this July. Luckily for the now retired nurse, having worked at UCLA Medical Center, Santa Monica, she knew exactly where to turn.
Just one week after being diagnosed, Abrams was sitting with her family in a room in the UCLA Breast Center, Santa Monica as a group of doctors came in one at a time to discuss her course of treatment.
“You get this devastating news and this made it easier,” Abrams said. “All the caregivers, all the medical providers came to us, which was so wonderful. I never felt at any minute that anybody was pressed for time. I felt that I was the most important person in that room.”
Abrams said that coming into a difficult situation, the doctors handled everything better than she could have hoped for.
“Any questions that I had or concerns I had were immediately addressed. It was seamless. It was just the best. I didn’t have to jump from office to office from appointment to appointment. And by the time I left there was a plan of care in place,” Abrams said.
Dr. Susie McCloskey, who works in radiation and oncology and is co-director of the center, said the idea for the center, established in 2012, came together very naturally among the doctors and leadership at the hospital in an attempt to improve the quality of care women were receiving.
“We wanted to increase communication and consistency and to deliver care in a really collaborative way among the doctors,” McCloskey said.
McCloskey said the way that occurred was twofold in terms of what patients have reported back to them.
“First, for women who were newly diagnosed, as opposed to having to go from appointment to appointment, doctor to doctor, in different locations at different times, we sort of brought all of the doctors to them under one roof. So certainly that convenience of care model was the major logistic change.
“The other thing that patients seem to love is that we hired a coordinator for the breast center who could be a single point of contact to help navigate what is otherwise a very complicated system.”
McCloskey believes these reasons are why their endorsement rates are almost 100 percent across the board.
Trying something different
Another component of the breast center that McCloskey is proud of is a treatment option they have which is not commonly offered elsewhere: prone breast radiation therapy.
“Opposed to how we traditionally set women up for breast radiation therapy which is called supine, and being set up on their back, prone is set up for radiation delivery laying on the belly,” McCloskey said.
The patient lies flat on their stomach on a special board with a hole meant for the affected breast to go into.
According to McCloskey, this way of receiving radiation treatment is beneficial to patients, especially those with larger breasts, for several reasons.
“One reason is that women tend to get the greatest severity of skin reactions out around the folds of the breasts, so when you displace those folds in the prone position the skin effects tend to be far less; there is a reduction in skin toxicity.”
There is also the matter of convenience, as patients receiving prone therapy are usually given shorter courses of whole breast treatment. Without prone, many women with larger breasts are not usually candidates for these shorter courses.
McCloskey said there is also the matter of the heart when it comes to prone, literally.
“There is no question that prone offers far less radiation doses to the lungs, and leads to less of the normal organ toxicity that radiation patients receive,” McCloskey said. “But women who have a larger breast size, or cancer in their left breast, spare the heart more this way as well.”
Abrams happens to have been a candidate for prone who just completed her radiation therapy. And though she knew nothing about the treatment beforehand, she is pleased with her experience.
“You know, actually coming in I was totally ignorant, despite being a medical person. I just had really no opinion, no information. But when we talked about it Dr. McCloskey suggested that, because it was on my left breast and because I have large breasts it would be a good option for me so that it could spare my heart and my heart muscle,” Abrams said.
Abrams, who does not like MRIs, ended up being able to handle this treatment no problem.
“It literally took five minutes a session. I would count to 100 and by the time I got to 100 it was done.”
Having been a nurse, Abrams is in a position to really evaluate how patients are treated, and she applied that thinking to how she herself was treated at the UCLA Breast Center, Santa Monica.
“As a patient, you want to be treated like you would treat your patients. And I definitely felt that and more. Being here was something that met my individual needs. What was going on with me at that moment was the most important thing to everybody and I did not feel like I was being neglected,” Abrams said.
McCloskey takes note of these concerns and tries to sympathize and accommodate her patients as best she can.
“We try to smooth the edges of what is always going to be an anxiety provoking situation,” she said.
And according to Abrams, they are doing just that.
“It’s frustrating when things don’t go the way you want with a patient. Here they’ve kind of got it nailed.”