Breast cancer (BC) is the commonest cancer in women and 4th most common cause of death from cancers in Australia. The pathway for BC patients from presentation to survival is complex involving multidisciplinary care and multiple care providers across different health systems (general practice, public and private hospitals). Although 5 year survival for BC in North Queensland is at par (92%) with national average, but patient and provider feedback have identified gaps in care. Optimal cancer care pathway (OCCP) has been developed to enhance quality of care. However its use and implementation needs to be studied further. Hence this systematic review.
Literature was reviewed using online databases like Medline (Ovid), PubMed, CINAHL, Embase, cochrane library, Web of science and DynaMed Plus. Of the 128 abstracts identified, 70 full publications were reviewed and of these 5 fulfilled the inclusion criteria for analysis. These were compared for various key characteristics like scope of use, study design, use of audit tools, implementation methodology, cancer care outcomes etc. Quality of study was assessed using the 16 item quality assessment tool (QATSDD).
Studies varied widely in their design, posed variable risk of bias and ranged from poor to moderate on quality (score 9-24). Scope of use of OCCP was limited to either within one health system or specific stage of BC. Implementation methodology was not clear and none of the studies reported on efficiency of care, economic outcomes, patient or provider feedback.
It is surprising that OCCP use in BC is so poorly understood and studied. A lack of common governance between various health systems makes its holistic implementation across the whole pathway difficult. Also small number of studies makes it hard to draw definitive conclusions. Future research is required into optimizing care pathway in BC.