The medical team took the lead in launching a "seamless" one-stop service in 2011, providing seamless and complete care from screening, special clinics, examinations, consultations, treatments, and post-treatment follow-up periods. . Text/Picture provided by Wu Peifen/Taipei Veterans General Hospital Cancer has topped the list of the top 10 causes of death in the country for 31 consecutive years. According to statistics from the Department of Health just released at the end of April this year, more than 90,000 people were diagnosed with cancer in 2010. Among them, breast cancer ranks first among the female cancer population. Zeng Lingmin, head of the multi-specialty breast cancer team of Taipei Wing General Hospital and the attending physician of the general surgery department of the hospital, said that the treatment of breast cancer is complex and it is impossible to make the best arrangements for patients with the expertise of a single department. Taipei Wing General Hospital through *** Surgery, medical oncology, radiology and pathological examination majors cooperate with each other to fully understand the characteristics of the disease and provide patients with the most appropriate and effective treatment with the least side effects and harm; at the same time, the drug treatments received by patients are all provided by professional clinical Pharmacists provide medication guidance and medication monitoring. Therefore, there has long been a diagnosis and treatment model in which various specialists who specialize in breast cancer treatment cooperate across departments. In recent years, the National Health Bureau of the Department of Health has commissioned the National Institutes of Health to handle the relevant regulations on cancer center evaluation. New regulations were enacted in 2007, requiring the establishment of a medical team for each cancer. In November 2007, the Taipei Wing General Hospital established a "patient-centered" multi-disciplinary integrated breast cancer medical team, and then the "Taipei Wing General Breast Cancer Multi-Specialty Team" was established. The official name of the "Medical Team" is directly affiliated with the Taipei Wing General Cancer Committee. Zeng Lingmin pointed out that Taipei Wing General Breast Cancer Multi-specialty Medical Team has served more than 5,000 patients in surgical treatment alone in the past 15 years, of which 14% to 15% were stage zero cancer patients. According to Zeng Lingmin's analysis of the statistics of 4,401 patients who underwent surgical treatment at Taipei Wing Hospital from 1997 to 2012, patients younger than 35 years old accounted for approximately 4.5% of all patients, and 54% of them had tumors less than 2 cm in diameter. 66.5% of the axillary lymph nodes tested negative and have not yet metastasized to cancer cells. 70% of the patients were positive for hormone receptors and 21% were strongly positive for the HER2 gene. However, for patients with positive hormone receptors, there is only about a 10% chance that the HER2 gene will be excessive. Performance. In addition to traditional pathological factors such as tumor size and lymphatic metastasis, breast cancer patients also have lymphovascular infiltration (referring to cancer cells infiltrating the lymphatic and vascular systems in the tissue matrix, which is more malignant), and younger patients (less than 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 poor. Although the prognosis for young breast cancer patients under the age of 35 is poor, with the continuous innovation of surgical techniques and breast cancer drugs, and the careful care of the medical team, the vast majority of breast cancer patients can achieve good treatment results. Overall The 5-year survival rate is over 83%. Zeng Lingmin said that the ideal state pursued by breast cancer treatment is that early-stage breast cancer can be cured, while late-stage breast cancer is treated as a chronic disease and treated as a chronic disease, hoping to still survive for a long time and have a good quality of life. In the past, breast cancer mostly occurred in European and American women. In recent years, due to the Westernization of Chinese diet and lifestyle, the number of people suffering from breast cancer has increased year by year. The breast cancer treatment models used in domestic medical institutions are mostly modeled after European and American countries. Taipei Rongzong In addition to referring to international cancer treatment standards (American National Comprehensive Cancer Network, NCCN and European ST. Gallen treatment standards), there is also a complete breast cancer patient treatment tracking database, which has been reviewed by in-hospital medical oncologists, radiation oncologists, pathologists, etc. We held multiple team meetings and analyzed and discussed the treatment results of nearly 5,000 cases to formulate clinical guidelines that are more suitable for Chinese people. "Based on Taipei Rongzong's rich experience over the years, although the physical constitutions of white and yellow people are different, various treatments The difference in effectiveness is not big. As long as the existing treatment guidelines in Europe and the United States are slightly adjusted, they can be applied to the situation of Chinese people." Zeng Lingmin said. Taipei Wing General Breast Cancer Multi-specialty Medical Team has a set of fixed procedures for diagnosis and treatment. Based on each patient's condition, medical staff will formulate a complete treatment plan through multi-specialty discussions and track the patient's condition. Taipei Wing General's multi-specialty medical team helped more than 560 patients newly diagnosed with breast cancer last year alone, completing surgical treatment and subsequent adjuvant drug or radiation therapy.
After more than 5 years of operation, the breast cancer multi-specialty medical team has received an endless stream of patients. Zeng Lingmin alone received more than 200 patients during one consultation. Some were follow-up cases of old patients, and some were simply ** * question. In order to allow patients with high risk of breast cancer to diagnose breast cancer more quickly and help patients gain a deeper understanding of breast cancer in a short period of time, the medical team took the lead in launching a "seamless" one-stop service in 2011, from screening to , special outpatient clinic, examination, consultation, treatment, and follow-up period after treatment, complete care without any gaps. Zeng Lingmin pointed out that the special clinic is mainly for appointments. On average, nearly 20 patients can be seen in half a day. It can be said to be a breast cancer expert clinic. Sometimes there are 6 to 8 newly diagnosed breast cancer patients in one consultation. In the outpatient clinic, doctors can spend time answering patients' questions and concerns. Patients are accompanied by volunteers from the patient group (Tongxinyuan) for medical consultation and examination, and can quickly determine whether they have cancer. Tongxinyuan Breast Cancer Patient Group has fixed outpatient and ward visit services every week to provide psychological support to breast cancer patients and also strengthen the relationship between the hospital and patients. Lian Peiru, a case manager who has been serving patients in the Taipei Wing General Breast Cancer Multi-specialty Medical Team since its establishment, said that the breast cancer special clinic is not a self-paid clinic, but a health insurance clinic. The main service targets are patients diagnosed with breast cancer who need consultation. Second opinions, and women who are highly suspected of having breast cancer through the National Health Bureau's free *** photography examination. According to Lian Peiru's many years of experience, after a patient is diagnosed, the doctor says that surgery is needed. Even if the doctor spends 20 to 30 minutes explaining the surgery process, the patient is in a disturbed mood and rarely listens calmly. Most of the time, he or she is in a calm mood after returning home. After looking at the information at hand, I found that I had a lot of questions. At this time, I called the case manager. Most of the questions asked were, "Is it safe to perform ***-sparing surgery?" "What stage is it?" "How many years can I live?" "Do I need chemotherapy?" etc. After the surgery and before the biopsy report is released, Patients are calling case managers again. A "case manager" is like a patient's "medical agent", responsible for the patient's entire course of treatment and providing a single window for consultation and contact. Whether patients have questions about postoperative wound care, rehabilitation issues, chemotherapy or radiotherapy treatments and side effects, they can consult case managers without worrying about being unable to find a doctor. When patients need to receive auxiliary chemotherapy or radiation therapy after surgery, personal therapists actively intervene to prevent patients from delaying the golden time of treatment due to lack of understanding of the treatment procedures. In addition, when patients need to be transferred to another hospital due to various factors, the case manager can also assist in arranging evacuation to the hospital so that the patient can continue to receive treatment. When encountering young female breast cancer patients, because of the pressure to have children, Lian Peiru also helped a patient in her 30s to protect her reproductive organs before treatment. Three years after the treatment, she successfully became pregnant and gave birth. There are also several young women who are worried that radiation or chemotherapy will affect their ovaries. With the help of Lian Peiru, they asked relevant medical staff in the hospital to freeze their eggs without delaying the treatment time. Cancer cells located in breasts are collectively called breast cancer. However, cancer cells that also grow in breasts have many different appearances. Some are complete and regular in appearance, and some are irregular and malignant. The degree of breast cancer is also different. Triple-negative breast cancer is considered to be a malignant breast cancer. Zeng Lingmin pointed out that 15% of breast cancer patients have triple-negative breast cancer, and these patients are negative when tested for estrogen receptor (ER), progesterone receptor (PR), and HER2 receptor molecular markers. Therefore, patients who are ineffective in hormonal drug therapy and targeted drug therapy can only receive traditional chemotherapy and radiation therapy, which is not required for every triple-negative disease. Because there are few treatment options, most cancer cells are differentiated into the worst grade (grade 3), which is easy to relapse, has a high mortality rate, and cancer cells can easily metastasize to the brain. In the West, it is more common in young women. However, according to the data analysis of Taipei Rongzong It has been shown that the age of triple-negative breast cancer in Chinese people is nearly 52 years old, but it is more likely to occur in older women. For this difficult group of triple-negative breast cancer, Taipei Wing General Breast Cancer Multi-specialty Medical Team and Yang-Ming University Medical Center cooperated, hoping to find New drugs and new treatment methods are developed to achieve the effect of suppressing cancer.
Zeng Lingmin's medical team collaborated with Yang-Ming University Medical Center to change part of the chemical structure of Bortezomib (the world's first synthetic protein-body inhibitor), a drug originally used to treat multiple myeloid cancer. This protein-body inhibitor will It affects the transmission of various messages within cancer cells, disrupts the stable environment inside cancer cells, leads to apoptosis of cancer cells, and delays tumor growth. By changing the chemical structure of Bortezomib, the proteosome inhibitor becomes more effective. It blocks the transmission of messages in cancer cells through different pathways and can also disrupt the stable environment inside cancer cells. Laboratory research has proven that it is effective. Triple-negative breast cancer has a very good curative effect, and the research results were published in a well-known international journal (2012 Breast Cancer Research). This new anti-cancer drug, which is a targeted therapy, has also been used to conduct research on the treatment of liver cancer. In addition to domestic academic institutions, the medical team itself has also participated in many multinational drug clinical trials. In early 2012, it was published in several multinational publications related to preoperative drug treatment of breast cancer, including the global index medical journal "The Lancet". Among the clinical research papers on sex, Zeng Lingmin is the representative author in Taiwan, and his contribution to transnational drug clinical trials has been recognized internationally. In addition to actively cooperating with academic institutions such as Yang-Ming University and other medical centers to conduct clinical and basic research, the medical team is currently also actively developing the technology of intraoperative radiotherapy for early breast cancer. This technology can preserve the current treatment of early breast cancer. After surgery, the traditional 5 to 7-week course of radiation therapy can be completed once during surgery, which will reduce the pain of early-stage breast cancer patients having to travel to the hospital for a long time after surgery, and can effectively improve the quality of life after surgery. Medical progress requires the continuous efforts of the medical team. "Seeing patients as close friends and pursuing excellence" allows all patients to receive safe and convenient medical treatment and receive world-class services. This has always been the goal pursued by Taipei Wing General Breast Cancer Team. Team members*** 4 attending physicians in surgery/3 attending physicians in medical oncology/3 attending physicians in radiation oncology department and 6 attending physicians in diagnostic radiology/*** 2 attending physicians in pathological diagnosis/2 plastic surgeons/clinical 1 pharmacist/1 psychotherapist/1 rehabilitation therapist/1 nutritionist/1 social worker 2 case managers/10 assistants This article is excerpted from issue 363