ONS Issues Position Statement on Short-Stay Surgery for Breast Cancer

The Oncology Nursing Society has responded to the increase of short-stay (“drive-through”) mastectomy and other forms of breast surgery for cancer.

Changes in the healthcare system have necessitated increased use of the outpatient setting for surgical procedures for cancer. Among procedures that increasingly are being performed in the ambulatory setting are those for breast cancer, including mastectomy, lumpectomy, and axillary lymph node dissection or sampling. In some instances, hospital length of stay is mandated by payors of health care with little regard to the physical or emotional needs or resources of patients and families. Because of the nature of breast cancer and its physical and psychoemotional impact on patients and their families, special issues have arisen concerning the use of short-stay surgeries in this population.

It is the position of the Oncology Nursing Society (ONS) that:

• Length-of-stay decisions must be made solely between the healthcare provider and the patient (and family) without influence of financial incentives.

• Decisions about length of stay must be based on individual patient variables (including co-morbid conditions, age, anesthetic risk, and attitudes toward short-stay), type of surgery, healthcare provider evaluation, and caretaker support, burden, and resources.

• An interdisciplinary team must be used to ensure comprehensive presurgical assessment and patient/caregiver education and preparation for self-care at home, as well as to evaluate readiness for discharge and to ensure appropriate communication, physical care, symptom management, follow-up evaluation, and continuity of care in the recovery and rehabilitation phases.

• Issues to be addressed with patients and caregivers must include physical care (eg, wound care, drain care, minimization of infection, postsurgical arm exercises) and symptom management (eg, pain, nausea, vomiting), and the social (eg, resources, transportation), psychological (eg, alterations in body image, femininity, sexuality) and emotional (eg, depression, anxiety) impact of breast cancer and its treatment.

• Patients and caregivers must be physically and psychologically prepared to manage self-care or caregiving in the home.

• Appropriate referrals, including referrals for social services and home care and to programs such as Reach to Recovery, must be made prior to discharge and evaluated for efficacy in the immediate recovery phase.

• Polices that mandate outpatient mastectomies must be eliminated.

For more information, contact the ONS Customer Service Department at 501 Holiday Drive, Pittsburgh, PA 15220 or call (412) 921-7373.