The Breast Health Centre at King Edward VII’s Hospital has evolved to become a world-leading centre for breast cancer. The state-of-the-art facility offers rapid screening and one-stop assessment, with access to specialist consultants who are leading the field in advanced surgical techniques and treatments.
But something else that sets the Centre apart is its focus on highly personalised, integrated care. Evidence demonstrates that a holistic approach to breast health has numerous benefits for patients, from reducing the stress of initial investigations right through to better adherence to treatment plans and improved emotional and physical wellbeing during their cancer journey and beyond.
Located in London’s Harley Street Medical District, King Edward’s VII’s Hospital’s Breast Health Centre has taken patient-centred care to a whole new level. Care is delivered by an expert multidisciplinary team that not only includes cancer surgeons, microsurgeons, radiologists and clinical nurse specialists, but also extends to physiotherapists, pain-management experts and clinical geneticists.
Breast Health Centre manager and clinical nurse specialist Amelia Cook explains that the team has raised the bar on personalised care: “Everything is tailor-made for each individual and our ethos is to work with the patient as a team,” she says.
Opened in 1899, King Edward VII’s is one of London’s oldest independent hospitals and, with just 56 beds, also one of the smallest. Along with its royal patronage and charitable status, this has helped it create a discreet and highly personalised approach to patient care.
Lead consultant surgeon at the Breast Health Centre, Mr Paul Thiruchelvam, highlights that this focus on bespoke treatment – together with a tight-knit group of physicians drawn from across London’s teaching hospitals, who work alongside specialist nursing staff – has enabled the centre to develop a shared vision.
“We put the patient very much at the centre of treatment,” he explains. “That involves delivering world-class cancer care, but also looking more widely at the patient as a whole. We not only look at the patient’s cancer needs, but also their emotional, social and spiritual wellbeing through their cancer journey.”
That personalised journey begins right from first contact with the patient.
Anyone over the age of 40 who simply wants a breast check-up and is not experiencing any symptoms can access the Centre’s mammogram screening service, provided they are registered with a GP in the UK. If they don’t have a UK GP, King Edward VII’s Hospital can connect them with one from its own team or a local practice.
“This ensures that, when the results go back to patients, they've got somebody overseeing their care. Even if they are absolutely fine, we always ensure the GP gets the results so that they can be discussed properly with the patient,” says Amelia.
Results are usually available on the same day, but, if there are concerns, patients will be invited back for a consultation with one of the Centre’s team of top radiologists. No two women are the same, and additional assessments might include 3D mammography or ultrasound, which can be used to get different images of the breast, and/or MRI or stereotactic biopsy. Crucially, says Amelia, the results are relayed back quickly and next steps discussed in detail with the consultant and clinical nurse specialist.
Speedy access and results can be even more important if patients are experiencing symptoms of breast cancer, such as a lump or discolouration – and the accompanying anxiety this can cause. Women – or, indeed, men – of any age who have worrying symptoms can self-refer to the Centre’s one-stop-shop “triple assessment”.
Regarded as the gold standard for diagnosis, triple assessment includes a physical examination, mammogram or ultrasound scan and, if needed, a biopsy. The whole procedure can be completed in as little as an hour. Most people can be reassured, but for those with a cancer diagnosis, the fact that the service is consultant-led means they can begin discussing treatment options straight away.
“Having a cancer diagnosis is extremely complex. There is a lot of information to take on board at a very difficult time, so it is really important that we tailor the care and the information we provide,” says Paul.
Ultimately, Paul explains, patients need to be empowered to make decisions about their personal treatment. “We have to make sure we talk about all treatment options, along with the particular advantages and disadvantages,” he says. “This is extremely important because we know that patients who are involved actively in their decision-making process have a much better cancer experience.”
Treatment options discussed might include surgical and non-surgical management, but much cancer care is multimodal and may include surgery alongside chemotherapy, radiotherapy and endocrine therapy.
King Edward VII’s Hospital is at the cutting edge of some of the most complex surgical procedures. Paul and his colleagues not only work closely as multidisciplinary teams, but are increasingly sharing the operating theatre to perform cancer surgery alongside advanced microsurgical techniques for breast reconstruction and lymphedema prevention. “Working with fellow consultants means you can undertake complex surgeries more expediently and safely,” explains Paul.
The team has been at the forefront of deep inferior epigastric artery perforator (DIEP) flap reconstruction – a highly complex autologous breast reconstruction procedure that uses the patient’s own abdominal tissue to recreate the breast mound. “It is an extremely complex procedure, but we have highly skilled microsurgical colleagues who are able to deliver outstanding outcomes and with extremely low rates of complications,” says Paul.
However, he adds, undertaking an immediate breast reconstruction may not be right for all women at the same time as cancer surgery. “For some patients, reconstruction may not be at the forefront of their minds, so they may opt to delay the procedure. It’s a very personal decision, but the important thing is that patients are offered a choice.”
Alongside advanced reconstruction techniques, King Edward VII’s Hospital is at the forefront of an innovative procedure to reduce the risk of lymphoedema – a chronic condition that causes swelling in the body’s tissues following cancer treatment.
The technique – called lymphatic microsurgical healing approach (LYMPHA) – can again be performed alongside cancer surgery. Effectively, it reconnects the lymphatic drains in the arm to the area under the shoulder joint to allow lymphatic fluid to flow freely back into the circulation.
Paul, who is a member of the expert panel on breast cancer-related lymphoedema and was involved in drafting best-practice guidelines for the American Society of Breast Surgeons, highlights that the technique has been shown to greatly reduce lymphoedema in patients whose treatment requires the removal of a large number of lymph nodes.
“Our team travelled to Genoa to visit Professor Francesco Boccardo, who first described the LYMPHA procedure. Our technique has evolved over the past four years and I am proud to say that we are about to carry out our 40th procedure,” Paul explains. “We are extremely fortunate to be able to offer it to our patients and potentially reduce their risk of developing this extremely debilitating condition.”
International links and Paul’s work with the American Society of Breast Surgeons have also helped the Breast Health Centre to integrate a range of complementary services into its treatment pathways to provide patients with 360-degree care. Post-operative pain and discomfort can be an additional problem for women undergoing cancer treatment, particularly after a mastectomy.
“There is a tailored protocol in the US around patients having pre-operative pain assessments to ensure that they don't develop a chronic pain cycle,” explains Paul. “And this is something I have integrated into my practice.”
The team now includes a dedicated consultant pain specialist, Dr Matthew Brown, who can assess women before their operation and design a bespoke post-operative pain management plan, as well as deliver complementary therapies such as acupuncture.
The Centre has also developed a unique physiotherapy programme where patients are seen before, as well as after, surgery. This gives the specialist physiotherapists a deeper understanding of the patient’s normal function so they can produce a post-operative plan that will get them back to full mobility as quickly as possible.
And for those patients whose clinical history indicates a genetic link, such as BRCA1 and BRCA2 mutations, King Edward VII’s Hospital is the only private hospital in London with a truly comprehensive genetics service. Lead by consultant clinical geneticists Professor Marc Tischkowitz and Dr Anjana Kulkarni, the service can also be extended to family members if a cancer-related gene mutation is identified.
A multidisciplinary approach has been shown to greatly improve governance and patient safety. However, to ensure it genuinely improves patient experience, it is vital that care is coordinated, which is where Amelia and fellow clinical nurse specialist Helen Froyd play a pivotal role.
“We are very fortunate to have two outstanding and experienced breast
care nurses,” says Paul. “They are absolutely key in the patient journey. They are the first point of contact for the patient and facilitate their appointments with the various members of the cancer team.” Indeed, Amelia and Helen are there to help patients navigate their care from that very first screening or assessment.
“That means we are there for patients right from diagnosis and often before,” says Amelia. “It’s really personalised care that we offer here. We’ll look at the whole person to see where we can target support. It’s very interactive and there are all sorts of touch points, from face-to-face clinics to text messaging. The important thing is that we are there when patients need us – even if it’s 10 o’clock at night, they can leave a message and we’ll call them back the next day.”
During treatment, Amelia and Helen carry out regular needs assessments to help identify any areas of concern for their patients – whether mental, physical, social or even financial. They can also perform micropigmentation – a tattoo-like procedure to recreate the nipple and areola following reconstruction surgery – and provide long-term support, in some cases years after treatment has finished.
“Even if patients are completely cured without any problems – and most women are – we will see them in follow-up a year later,” says Amelia. “And they will always have our contact numbers, so even if it is months or years down the line and they have a question or feel anxious about something, we are there to support and advise.”
According to Paul, it is this very high-level support that can make a real difference for patients coming to terms with a diagnosis and what can be a long road to recovery. “What patients value most is being looked after by an experienced team guiding their care,” he says.
“Knowing that there is a group of people who want the very best outcome for them helps patients get through their cancer treatment, and it’s an honour to be part of that team delivering a world-class level of care.”
To book an appointment or speak to a specialist at King Edward VII's Hospital Breast Health Centre, call +44 (0)20 4571 3373 Monday to Friday 9am-5pm, or visit kingedwardvii.co.uk