Clearing a cancer care path for 25 years

By Kirstin Grace-Simons (Madigan Army Medical Center)October 23, 2019

Genevieve, clinical coordinator
1 / 3 Show Caption + Hide Caption – Madigan Army Medical Center's Breast Cancer Pathway Clinical Coordinator, Genevieve Fuller, an advanced registered nurse practitioner, welcomes people to a 25th anniversary celebration of the program and clinic at Madigan on Joint Base Lewis-McChord,... (Photo Credit: U.S. Army) VIEW ORIGINAL
Pathway team
2 / 3 Show Caption + Hide Caption – (Photo Credit: U.S. Army) VIEW ORIGINAL
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MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. -- For 25 years, Madigan Army Medical Center has had a holistic program to walk with those with breast cancer from initial screening through many years post-treatment.

On Oct. 16, the Breast Cancer Pathway team celebrated the silver anniversary of their clinic's work with a cake cutting and a few words of gratitude for the support the program has received over the years.

"It doesn't matter where we work in this building, we come together in a wonderful team approach to take care of our patients," said Genevieve Fuller, an advanced registered nurse practitioner and clinic coordinator for the Pathway program that is centered in the Radiology Department.

The Pathway program manages care for an average of 85 breast cancer patients each year within an area that used to be a large waiting room for Radiology. These are just the diagnosed patients who are going through treatment. Radiology itself performs 600-800 mammograms a month.

Although rare, men do develop breast cancer too; they receive treatment in the Pathway program. The last two years has seen an unusually high number of male patients with three.

Fuller was there at the inception of this unique program in 1993 when she represented Radiology on the 12-member team that was tasked with designing a plan to answer the question she still asks to ensure her work is on the right track, "Are we providing appropriate, timely care in as seamless a fashion as we can for our patients? That's what we've worked towards all these years," she said.

Since its start, the program has constantly sought the leading technology and techniques to ensure its patients are getting a diagnosis and treatment as early as possible, thereby increasing the chances of a full eradication of cancerous cells.

Testing and screening capabilities have advanced significantly in the program's 25 years. Strategic thinking in managing the long-term journey a patient takes through cancer treatment has also been vital to the program's effectiveness.

"A case manager was added to oversee patients going to treatment to help them keep on track with their follow up appointments," explained Fuller.

In 2016, a survivorship piece was added that is now required for accreditation. This provides a plan written for the patient that they can take to their primary care manager to get all the follow up screenings and care they will need post-treatment.

The Pathway program, through the nurse case manager and survivorship plan, follows patients for a minimum of 5 years and up to 10, depending on the treatment they receive.

"The survivorship plan is instituted for the patient's benefit," noted Fuller.

Another current Pathway team member who was on the design team for the program and at the ribbon cutting ceremony for the clinic on Oct. 19, 1994 is Dr. Preston Carter, a general surgeon.

In addition to surgery, patients in the program are cared for by a team that includes a nurse case manager, social worker, medical and radiological oncologist and possibly a plastic surgeon.

From the program's first days, patients have been met with team care.

"It was decided it would be a team approach, from the beginning -- multidisciplinary," said Fuller. "When the patient sees her first treatment planning appointment, it is with the team. Everybody hears the same questions, same answers, same explanations, same concerns."

Madigan's Pathway team also ensures that when a patient moves away from its services, whether because of a permanent change of station, a compassionate reassignment to be closer to family or by leaving the military, their new care providers get a warm handoff.

Beyond this wide-ranging impact, the Pathway program has influenced other facilities both in military medicine and in the civilian healthcare realm. According to Fuller, when residents and clinicians move elsewhere, they often look to add elements of Madigan's program in their new clinics.

When asked about the Pathway team, Fuller gushed, "I just could not say enough about the collegiality and the support our patients get. It's all about the patients."

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