Chapter 26: A Brief History of Breast Medical Oncology
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Description
In this chapter, Dr. Hortobagyi begins an overview of the evolution of Breast Medical Oncology and the Breast Center. He recalls that in the early days, the Department needed to communicate better to develop patient care. As an example, he points out that scheduling sequential consults with specialists could take weeks, greatly slowing progress on a patient’s treatment plan. Bi-weekly meetings were established with all related specialties to aid communication and come up with a majority view of what needed to be come. Dr. Hortobagyi explains the specialties represented and how some individuals resisted collaboration on treatment plans. He notes that it took years for difficulties to smooth out, but that patients were happy and grateful. Dr. Hortobagyi says that the patients had figured out that it was good to get their doctors talking to one another. The multidisciplinary meetings were an educational tool and an instrument for cultural change in the department, he observes. Surgeons had been in charge of managing breast cancer, but slowly imagers and breast medical oncologists made inroads and with good results. He also says that conflict over treatment plans could give rise to clinical trials to prove a point (e.g. demonstrating the benefits of different types of surgery and of integrating chemotherapy at different stages of treatment and in combination with radiotherapy and immunotherapy).
Dr. Hortobagyi describes the successes that came from multidisciplinary discussions of treatment. “We were leaders in breast cancer management,” he says. “Everything we proposed and developed has survived the test of time.”
Identifier
HortobagyiGN_05_20130315_C26
Publication Date
3-15-2013
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Gabriel Hortobagyi, MD, Oral History Interview, March 15, 2013
Topics Covered
The University of Texas MD Anderson Cancer Center - An Institutional Unit MD Anderson History MD Anderson Culture Building/Transforming the Institution Multi-disciplinary Approaches Growth and/or Change The MD Anderson Brand, Reputation Institutional Mission and Values Giving Recognition
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey Ann Rosolowski, PhD:
Okay. So we are recording, and I’ll just put the quick identifier on. This is Tacey Ann Rosolowski, and today is March 15, 2013. The time is about 1:18. I am interviewing Dr. Gabriel Hortobagyi for our fifth session together, so thank you for agreeing to this final session.
Tacey Ann Rosolowski, PhD:
I wanted to ask you a couple of questions to recapture some material that was lost on the last interview. We were talking about the development of breast medical oncology. It’s really the first phase of that that we needed to recover. You had begun talking about the complexity of the process of bringing together all the components to create patient-centered care in breast medical oncology. You started your reflections on how that process really began with the biweekly meetings. So I wonder if you could talk a little bit about those biweekly meetings and then how that process of developing patient-centered care evolved from that.
Gabriel Hortobagyi, MD:
In the early days, it became apparent that we needed to communicate better and more in real time in order to work out the best sequence and combination of treatments for individual patients and also to avoid patients wasting their time. Because when you do consultations in a sequential mode and you depend on each individual’s schedule, then if you need four or five specialists involved, it can take literally weeks until everybody gets to see the same patient. So we developed these meetings where all of the relevant specialists were in the same room at the same time, and we would present a small number of patients for discussion including their imaging and their pathology, and the opportunity for the physicians in the room to briefly examine the patient, if that was needed. Then at the end of that conference, one would be able to come up with a—hopefully with a consensus, but certainly with a majority view as to what needed to be done. That was a little bit challenging to implement because at the beginning various dominant specialists felt that they already knew how to treat breast cancer, and they really didn’t need anyone else telling them how to do it. It took a little bit of overcoming resistance by showing the actual benefit of multidisciplinary programs.
Tacey Ann Rosolowski, PhD:
And how did that show itself?
Gabriel Hortobagyi, MD:
Well, sometimes there were heated discussions and resistance from one side to someone else’s idea about how to integrate various treatments. Sometimes people would get hot under the collar and walk out of the room. Sometimes individuals who were supposed to implement the consensus decision refused to do so. There were a number of different ways when that happened, and it took really years until this smoothed out. But the patients were very happy and grateful for having the opportunity to access multiple specialists at the same time. It saved them time, and I think they had figured out even before their doctors that getting their doctors to talk was a good thing. And then, I guess, we also figured out that in addition to being a tool that would benefit patients, it also became an educational tool and an instrument for cultural change and that gradually even the most vocal opponents of change would relent. So the old saying—if at first you don’t succeed, try and try again—was clearly in play here because we continued to have these meetings, and often we would have the same discussion time and time again about different patients but the same topic. Should surgery come first? Should chemotherapy come first? Should we use radiotherapy? Should we use radiotherapy before surgery or after surgery? What was the role of hormones, et cetera? While we started out—at least our surgeons and radiation oncologists started out—with pretty fixed positions because they had really been in charge of managing breast cancer at this institution for the previous several decades, slowly the medical oncologists and the imagers and the pathologists started to have some inroads into the discussion. And after a number of patients had responded favorably to interventions by medical oncology and their surgeons and radiation oncology started to see those results, then things started to change. Of course, the more they changed, the more rapidly they started to change because once you establish some degree of credibility, it is easier to reinforce that credibility.
Recommended Citation
Hortobagyi, Gabriel N. MD and Rosolowski, Tacey A. PhD, "Chapter 26: A Brief History of Breast Medical Oncology" (2013). Interview Chapters. 1131.
https://openworks.mdanderson.org/mchv_interviewchapters/1131
Conditions Governing Access
Open
