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Saturday, 2 March, 2002, 00:59 GMT
Breast care cost questioned
Breast scan
One stop clinics cost more per patient
One-stop clinics for assessing women with suspected breast cancer may not be as cost effective as previously thought, a study suggests.

They were compared with dedicated breast clinics and found to cost 32 extra per patient, mainly due to extra staffing costs.

In the study, 670 women over 35 who were referred to hospital with a breast lump were randomly allocated to attend either a dedicated breast clinic or a one-stop clinic.

The costs and benefits of each clinic were measured and compared.

One stop clinics significantly reduce short-term anxiety but do not have long-term effects

Michael Dixon, consultant, Edinburgh Breast Unit
One-stop clinics offer a diagnosis and treatment plan in one visit.

They were assumed to be more cost effective because pre-diagnostic visits are reduced.

However, more time is needed to discuss findings with patients, and management and consultant radiologists and pathologists need to be present for the whole clinic, even if they are not always needed.

The study, published in the British Medical Journal, found those attending the one-stop clinic were less anxious 24 hours after their visit, but not at three weeks or three months.

Dr Paola Dey, who co-ordinated the study, said: "Same-day reporting benefits only those women who otherwise would not have been given a diagnosis at their first visit to a dedicated breast clinic.

"However, in this trial, nearly 50% of women attending a dedicated clinic were given a diagnosis at this visit."

The costs saved by reducing the number of visits are more than offset by the staff costs of same-day reporting, say the authors.

Benefits of one-stop clinics are mainly short term and may not justify the added costs, they conclude.


In an accompanying article, Michael Dixon, a consultant surgeon at Edinburgh Breast Unit, said the one-stop clinics should not be abandoned on the basis of this research.

He said: "One-stop clinics significantly reduce short-term anxiety but do not have long-term effects.

"Anecdotally, doctors attending our clinic as patients report that a one-stop service minimises distress not only for them, but for their partner and family and limits the disruption to their own and their patients' lives.

"A significant improvement in patients' rating of their experience attending diagnostic breast clinics followed the introduction of a one-stop clinic in Edinburgh."

Cancer Research UK believes one-stop clinics should not be judged in terms of value for money.

Professor Lesley Fallowfield, from Cancer Research UK's Psychosocial Oncology Group said: "Other researchers have shown that there are short-term advantages in anxiety especially for those women for whom the result is good news but the cost of this is not just economic.

"Women for whom the diagnosis is breast cancer appear to benefit from a little longer period to receive the news.

"My feeling is that the one-stop clinic just reinforces the idea that breast cancer is a dire medical emergency, which it is not; rather breast cancer is an emotional emergency.

"We need more work like this to inform the debate."

One in 12 women will develop breast cancer, which is now the most common form of the disease in the UK.

There are an estimated 39,500 new cases of breast cancer diagnosed in the UK every year.

See also:

02 Jan 02 | Health
Breast cancer care questioned
01 Dec 01 | Health
Women fail to spot breast cancer
05 Nov 01 | Health
Breast 'most common cancer'
17 Mar 00 | C-D
Breast Cancer
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