The senological associations, certified breast centres, scientific societies and patient representatives in Germany have published a joint position paper on the outpatient treatment of selected breast cancer surgeries. They support the political goal of a stronger outpatient implementation in principle, but urgently call for a comprehensive remuneration model that covers all quality-relevant services. Under the current framework conditions, there is a risk of significant underfunding of central elements that are indispensable for the quality of care and patient safety.

Breast cancer surgery is embedded in complex, multimodal therapy processes and requires interdisciplinary cooperation as well as intensive medical, nursing, physiotherapeutic and psychosocial care. Essential components such as pre- and postoperative interdisciplinary tumor conferences, counseling by breast care nurses, psycho-oncology, social services, early mobilization through physiotherapy, guideline-based imaging, pathological diagnostics and study-related tasks are not or only insufficiently reflected in the outpatient reimbursement system. These services are established in certified breast centers and scientifically proven for better chances of survival, quality of life and safety.

The position paper emphasises that outpatient treatment can offer advantages such as shorter hospital stays and faster reintegration into everyday life, but has clear limits: the psychological stress on those affected, the need for close follow-up care and the complexity of many cases require comprehensive structures. Without adequate funding, there is a risk of dismantling interdisciplinary teams, restrictions on psychosocial support, a decline in study participation, jeopardizing certification and overall lower security of supply.

The signatories therefore demand:

• A comprehensive remuneration model that includes all quality assurance services outside the surgical procedure,
• The financing of a multidisciplinary care package including psycho-oncology, physiotherapy, social services, breast care nurses, tumour conferences and perioperative diagnostics,
• The consideration of certification requirements in outpatient remuneration,
• The participation of professional associations, certified centres and patient representatives in the further development,
• Clear indication criteria that enable vulnerable or multimorbid patients to continue to receive inpatient treatment.

The associations emphasise that outpatient care is only patient-oriented and sensible if it does not come at the expense of the quality of care. Politicians and decision-makers are called upon to create sustainable framework conditions in a timely manner.

Original Paper:

Statements | Guidelines & Statements | DGS

Editor: X-Press Journalistenbüro GbR

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