programme, however, the most important advancements with respect
to improving costs, resource allocation, length of stay, quality of life
and patient satisfaction, have been made in identifying the fact that
the patient's journey must involve and empower all members of the
multidisciplinary care team.
Our Standardized Pathways now include specific input and
involvement from every specific stakeholder that works with the
patient from the time of the referral until three years after the
completion of their therapy. More than any other issue, it is this
specific involvement of the entire multidisciplinary team, which we
think has been key to our outcomes.
YOU HAVE PURSUED A RELENTLESS REFINEMENT OF
PROCESS AND QUALITY MEASURES IN OESOPHAGEAL
AND THORACIC SURGERY. COULD YOU HIGHLIGHT TWO
SPECIFIC PROCESS OR QUALITY METRICS THAT WOULD
ILLUSTRATE THE EXTENT OF THE PROGRESS ACHIEVED
SINCE THE MID-EIGHTIES?
We are currently in the process of publishing the evolution in our
pathway and clinical outcomes over the last 20 years. We have seen
progressive improvements during that period in spite of patients
presenting at more advanced age with higher levels of co-morbidities
and more advanced disease. The critical quality metrics that we must
be presenting to our patients, now or in the future, is to provide
specific evidence that we can do complex operations with minimal
or no mortality, while also limiting morbidity, and that we can return
patients to a reasonable quality of life in the short term, provide them
with the highest level of expectation regarding cancer survivorship
and, during this whole process, provide them with a supportive
infrastructure which leads to high levels of patient satisfaction.
IN THE CONTINUING PURSUIT OF IMPROVED
OUTCOMES IN OESOPHAGEAL AND THORACIC SURGERY,
WHAT DO YOU PREDICT WILL BE THE MOST SIGNIFICANT
`WINS' ACHIEVED IN THE NEXT THREE TO FIVE YEARS?
The most significant advancement with respect to oesophageal
cancer therapy within the next decade will include refining our
techniques for treating selected patients with early oesophageal
cancer and high-grade dysplasia in Barrett's with endoscopic, and not
surgical, modalities. The greatest progress, however, will be related
to an increasing understanding of targeted therapy with respect to
the chemotherapy treatment for oesophageal cancer and identifying
certain genetic profiles that will allow us to refine our treatment
approaches to individualise treatment in each patient.
WHEN YOU DELIVERED THE 89TH ABRAHAM COLLES
LECTURE AT RCSI ON CHARTER DAY, YOU COMMENTED
THAT SURGEONS NEED TO BETTER UNDERSTAND THE
BROAD SPECTRUM OF ISSUES WHICH CONTRIBUTE TO
PATIENT SATISFACTION. CAN YOU EXPLAIN WHY YOU
FEEL THIS IS SO IMPORTANT?
Patient satisfaction has increasingly become a more recognised
quality measure in the US through the efforts of the American
College of Surgeons. Surprising to most of us, patient satisfaction is
not necessarily related to the clinical or technical successes of cancer
therapy. Patient satisfaction is most commonly related to providing
a meaningful and supportive communication infrastructure so
that patients feel that they are working with individuals who can
communicate with them and their families in an effective way, while
providing a balanced perspective with respect to their treatment
WHAT ARE THE KEY INITIAL STEPS THAT COULD BE
TAKEN TO BRING ABOUT THE CENTRALISATION OF THE
DELIVERY OF HIGH-RISK CANCER TREATMENT?
This process is well underway in many European countries
such as the UK, Ireland, Netherlands, Denmark and France.
Unfortunately in the United States, although there are high volume
and well-known cancer centres, the delivery of high risk procedures
is still delivered in a non-centralised manner at the present time.
Centralising care for high-risk cancers has the potential to not only
improve short- and long-term outcomes but also, due to parallel
improvements in process, decrease the cost of service delivery and
improve our opportunities for centralising important research
I UNDERSTAND YOU ENJOY A ROUND OF GOLF, YOU
PLAY ANNUALLY IN THE PRO-AM OF THE PGA SENIOR
EVENT, `THE BOEING CLASSIC'. AS A FREQUENT VISITOR
TO IRELAND, HAVE YOU HAD A CHANCE TO PLAY ON
ANY IRISH COURSES?
Especially when I was in University, I used to golf on a regular
basis. It remains one of the great joys of my life, even though I do
not get the opportunity to do it with any degree of regularity due
to the time requirements of my clinical practice. Virginia Mason
Medical Center has the honour to be the philanthropic beneficiary
of the Boeing Classic every year which is the reason I have had the
opportunity of playing in the Pro-Am over the past seven years. This
experience has provided the opportunity to see how golf should
really be played, and to meet some truly wonderful professional
golfers. I have had the pleasure of visiting Ireland on six occasions
and on two occasions, once with colleagues and once with my son,
we spent four or five days playing golf on some of the iconic courses
throughout Ireland. It remains one of my fondest memories of golf
and international travel.
COULD YOU DESCRIBE YOUR REACTION TO
RECEIVING THE HONORARY FELLOWSHIP OF RCSI?
Receiving the Honorary Fellowship of RCSI was an enormous
honour and a completely enjoyable experience. Recognition of
this type comes to only a small fraction of surgeons during their
career and I will always regard it as one of the seminal events in
my professional life. To understand the significance of this type of
recognition, one has only to look through the list of people who have
given the Abraham Colles Lecture in the past. The fact that I was able
to share this wonderful event with my wife and so many good friends
and colleagues from Ireland made it even more special.
Professor Donald Low and
Professor Patrick Broe.