On 20 1 1, the medical team took the lead in launching a "seamless" one-stop service, providing complete care from screening, special needs clinic, examination, consultation, treatment and post-treatment follow-up period. Text/Image courtesy of Wu Peifen/Cancer of Taipei Veterans General Hospital has been the top cause of death in China 10 for years. According to the statistics released by the Department of Health at the end of April this year, more than 90,000 people were diagnosed with cancer in 20 10, among which breast cancer ranked 1 among women with cancer. Zeng, the head of the multidisciplinary breast cancer team of Taipei Rongzong, who is also the attending physician of general surgery in the hospital, said that the treatment of breast cancer is complicated, and it is impossible for a single department to make the best arrangements for patients. Through the cooperation of surgery, oncology, radiology and pathological examination, Taipei Rongzong fully understands the characteristics of the disease and provides patients with the least side effects and the most suitable and effective treatment. At the same time, the drug treatment received by patients is guided and monitored by professional clinical pharmacists. Therefore, for a long time, there has been a multi-disciplinary cooperation model among various experts specializing in breast cancer treatment. In recent years, the National Health Bureau of the Department of Health has entrusted the National Institutes of Health to handle the relevant regulations on the evaluation of cancer centers, stipulating that every cancer must have a medical team. Therefore, Taipei Rongzong established a "patient-centered" multidisciplinary breast cancer medical team from June 2007 to October 2007. It has been pointed out that in the past 15 years, the multidisciplinary medical team of breast cancer in Taipei Rongzong has served more than 5,000 patients, of whom 14% ~ 15% are zero-stage cancer patients. According to the statistical data of 44,065,438+0 patients who underwent surgical treatment in Taipei Rongzong from 65,438+097 to 2065,438+02, patients under the age of 35 accounted for about 4.5% of all patients, of which 54% patients had tumors less than 2 cm in diameter, 66.5% patients had negative axillary lymph nodes, and 70. In addition to the traditional pathological factors such as tumor size and lymphatic metastasis, patients with breast cancer are accompanied by lymphatic infiltration (meaning that cancer cells will infiltrate lymphatic vessels and vascular system in tissue matrix, which is relatively malignant), and the patients are young (under 35 years old). Even if the tumor area is small and the cancer cells have not metastasized to other parts of the body, the treatment effect of breast cancer is not good. Although the prognosis of young breast cancer patients under the age of 35 is poor, with the continuous innovation of surgical techniques and breast cancer drugs, most breast cancer patients can get good treatment results under the careful care of the medical team, and the overall 5-year survival rate can reach more than 83%. It has been said that the ideal state pursued by breast cancer treatment is that early breast cancer can be cured, while advanced breast cancer is treated as a chronic disease, hoping to survive for a long time and have a good quality of life. In the past, breast cancer often occurred in European and American women. In recent years, due to the westernization of diet and lifestyle in China, the population suffering from breast cancer has increased year by year. Most of the breast cancer treatment models used by domestic medical institutions are modeled after those of European and American countries. In addition to referring to the international cancer treatment standards (National Comprehensive Cancer Network, NCCN and European St. Gallen's treatment standards), and because of the perfect tracking database of breast cancer patients, after many team meetings of oncologists, radiation oncologists and pathologists in the hospital, and taking into account the analysis and discussion of nearly 5,000 treatment results, a more suitable clinical standard was formulated. "With the rich experience of Taipei Rongzong for many years, although whites and yellow people have different constitutions, the effects of various treatments are not much different, as long as a small part of them fine-tune Europe and the United States." Once said. Taipei Rongzong Breast Cancer Multidisciplinary Medical Team has a set of fixed consultation and treatment procedures. According to the condition of each patient, the medical staff worked out a complete treatment plan through multidisciplinary discussion and followed up the patient's condition. Last year alone, Taipei Rongzong's multidisciplinary medical team helped more than 560 newly diagnosed breast cancer patients complete surgical treatment and follow-up adjuvant drugs or radiotherapy. After more than five years' operation, the patients of multidisciplinary medical team for breast cancer are in an endless stream. There are more than 200 patients who have come to see a doctor, including old patients who have been followed up and those who have simple problems. In order to make high-risk patients with breast cancer diagnosed more quickly and help them have a deeper understanding of breast cancer in a short time, the medical team took the lead in launching a "seamless" one-stop service on 201,providing complete care from screening, special outpatient service, examination, consultation, treatment and follow-up after treatment. It has been pointed out that the specialist outpatient service is mainly by appointment, and the average half-day outpatient service time can see nearly 20 patients. It can be said that it is a breast cancer expert clinic, and sometimes there are 6 ~ 8 newly diagnosed breast cancer patients in one clinic. In special clinics, doctors can spend time answering patients' questions and concerns. Accompanied by volunteers from the patient group (Tongxin Garden), patients can quickly determine whether they have cancer. Concentric breast cancer patients' group regularly visits clinics and wards every week, providing psychological support for breast cancer patients and strengthening the relationship between hospitals and patients. Lian Peiru, a case manager who has been serving patients since the establishment of the multidisciplinary breast cancer medical team of Taipei Rongzong, said that the special breast cancer clinic is not a self-funded clinic, but a health insurance clinic, which mainly serves patients who have been diagnosed with breast cancer and need a second opinion, as well as women who are highly suspected of having breast cancer after free photo examination by the National Health Bureau. According to Lian Peiru's years of experience, after the patient was diagnosed, the doctor said that surgery was needed. Even if the doctor spent 20 to 30 minutes explaining the operation process, the patient's mood was disordered and he could hardly hear clearly. Most of them went home and calmed down. They looked at the information at hand and found many problems. At this point, they will call the case manager. The most frequently asked question is "Is it safe to do * * * reserved surgery?" "Which issue is it?" "How many years can you live?" "Do you want chemotherapy?" Wait, wait until after the operation and before the biopsy report comes out, the patient will call the case manager again. The "case manager" is like the "medical agent" of the patient, who is responsible for all the treatments of the patient and provides a single consultation and contact window. If patients have questions about postoperative wound care, rehabilitation, chemotherapy or radiotherapy treatment and side effects, they can consult the case manager, without worrying about finding a doctor and having no recourse. When patients need adjuvant chemotherapy or radiotherapy after operation, nurses take the initiative to intervene to prevent patients from delaying the prime time of treatment because of their ignorance of treatment procedures. In addition, when the patient needs to be transferred for various reasons, the case manager can also assist in arranging the patient to be transferred so that the patient can continue to receive treatment. I met a young female breast cancer patient. Because of the pressure of childbirth, Lian Peiru once helped a patient in her thirties to do reproductive organ protection before treatment. After three years of treatment, she successfully got pregnant and gave birth. There are also several young women who are worried that radiotherapy or chemotherapy will affect their ovaries. With the help of Lian Peiru, under the principle of not delaying the treatment time, they asked the relevant medical staff in the hospital to cryopreserve the oocytes. Cancer cells located in * * * are collectively called breast cancer. However, cancer cells that also grow in * * * have many different appearances, some are complete and regular, some are irregular, and the degree of malignancy is different. Among them, triple negative breast cancer is considered malignant. Zeng Lingmin pointed out that 15% of breast cancer patients belong to triple negative breast cancer, and molecular markers such as estrogen receptor (er), progesterone receptor (PR) and HER2 receptor in these patients are all negative. Therefore, patients are ineffective in hormone drug therapy and targeted drug therapy, and can only receive traditional chemotherapy and radiotherapy, not each one. Because there are few therapeutic weapons, cancer cells are mostly differentiated in the worst grade 3, which is easy to relapse and has a high mortality rate, and cancer cells are easy to transfer to the brain. In the west, they are more common among young women. However, according to the data analysis of Taipei Rongzong, the onset age of triple negative breast cancer in China is nearly 52 years old, but it is more common in older women. For this group of refractory triple-negative breast cancer, the multi-disciplinary medical team of Taipei Rongzong cooperated with Yangming University School of Medicine, hoping to find new drugs. Zeng's medical team cooperated with the Institute of Medicine of Yangming University to make bortezomib (the world's first synthetic protein? Part of the chemical structural formula of the body inhibitor), this protein? Somatic inhibitors will affect the transmission of various information in cancer cells, disintegrate the stable environment inside cancer cells, lead to cancer cell apoptosis and delay tumor growth. Protein after changing the chemical structure of bortezomib? Somatic inhibitors become more effective, which can block the information transmission in different paths in cancer cells and disintegrate the stable environment inside cancer cells. Laboratory studies have proved that it has a good curative effect on triple-negative breast cancer, and the research results are published in the internationally renowned journal (20 12 Breast Cancer Research). This new anticancer drug, which belongs to targeted therapy, has also been used in the research of liver cancer treatment. In addition to domestic academic institutions, the medical team itself has also participated in many multinational drug clinical trials. At the beginning of 20 12, it was published in many transnational clinical research papers related to preoperative drug therapy for breast cancer, including the global index medical journal The Lancet. He was a representative writer in Taiwan Province, China, and his contribution to transnational drug clinical trials was recognized internationally. In addition to actively cooperating with Yangming University and other academic institutions and other medical centers for clinical and basic research, the medical team is now actively developing the technology of intraoperative radiotherapy for early breast cancer. This technology can save the traditional radiotherapy time of 5-7 weeks after early breast cancer surgery, and will reduce the pain of long-term running to the hospital after early breast cancer surgery, and effectively improve the quality of life after surgery. The progress of medical care needs the continuous efforts of the medical team. "Caring for patients and pursuing Excellence" has always been the goal of Taipei Rongzong Breast Cancer Team, so that all patients can see a doctor with peace of mind and get world-class service. Team members * * * 4 attending surgeons/3 in charge of oncology/3 in charge of radiation oncology/6 in charge of radiation diagnosis/* * 2 in charge of pathological diagnosis/2 in charge of plastic surgery/clinical pharmacists 1/ psychotherapists 1/ rehabilitation workers 1/ nutritionists 1.