Welcome to Westmead Breast Cancer Institute

This information guide is also available in PDF format to download.

Welcome on your first visit to the Westmead Breast Cancer Institute (BCI). BCI provides comprehensive, co-ordinated clinical care for patients with breast cancer and non-cancer breast disease. BCI brings together the expertise of specialist medical, nursing and allied health professionals in a multidisciplinary treatment model of care.

What type of clinics are available?

BCI provides care for people with breast disease, through specialised breast cancer clinics, diagnostic imaging and preoperative workups across a number of sites within Western Sydney Local Health District. While the majority of BCI specialised clinics are based at Westmead, our breast care teams work across Western Sydney hospitals and wherever possible we provide some diagnostic and treatment services closer to where you live including Blacktown/Mt Druitt and Auburn Hospitals.

Westmead Hospital Campus

Multidisciplinary Team Case Conferences
– Monday, Wednesday and Friday mornings

Diagnostic/Interventional Imaging Clinics
– Monday to Friday mornings

High Risk/Familial Care Clinics – Thursday mornings

Breast outpatients Clinics (surgical/adjuvant treatments)
– Monday, Wednesday and Friday afternoons

Nurse led wound clinics are held each day Monday – Friday

Blacktown/Mt Druitt Hospital Campus

Multidisciplinary Team Case Conferences
– alternate Thursday mornings

How does a new patient multidisciplinary clinic work?

At Westmead Breast Cancer Institute, patients with proven breast cancer are seen by a multidisciplinary team. This means that over the course of your diagnosis and treatment you may be seen by several different doctors from breast surgery, breast imaging, radiation oncology and medical oncology specialities, as well as nurses, radiographers and physiotherapists and other health professionals. The doctors caring for you will be a group of specialists and their teams. You may not necessarily be seen by the specialist consultant at each visit; however, all members of the multidisciplinary team are trained in breast cancer care and work together to plan your treatment.

On your first visit you will initially be seen by a doctor who will gather information and present your case to the multidisciplinary team meeting held the same day. Depending on the number of patients being discussed this meeting may take up to 2 hours. After that meeting you will be seen again to discuss your options and future steps or investigations as recommended by the multidisciplinary team. As a patient you have the benefit of the knowledge and expertise of the team of breast cancer specialists in suggesting what is best for your individual situation.

What does this mean for me?

At your first visit to the BCI you may be at the clinic for between 4 – 6 hours. Every patient is important and we provide dedicated time to each individual and to the complexities of each patient. The following details are provided so that you know what to expect during your visit.

What do I bring to my first appointment?

On arrival you will welcomed by our team. Please bring

> your valid Medicare card and
> An up-to-date referral letter from your General Practitioner (GP) stating the name of the specialist to whom you have been referred or a non-directed referral which means you have been given an appointment with our first available breast surgeon. A referral from a General Practitioner is usually valid for 12 months from your first visit, a referral from a specialist is valid for three months.
> X-ray images and reports from your most recent mammogram and ultrasound
> Any results from related tests such as biopsies, so they can be reviewed by your doctors

One accompanying support person is welcome at your consultation. It is often helpful to have someone with you when you attend.

If you do not have a valid Medicare card, you can still attend the clinic. The administration staff will give you an Outpatient Charges for Overseas Visitors form and ask that you settle this account with the cashiers department (on Level 2 of Westmead Hospital) prior to being seen by the doctors in the clinic.

As waiting times can vary and you may see a number of different health professionals on your appointment day, you may wish to bring along something to keep you occupied (book, iPad, knitting etc.). We do have a small library of books available. Extended wait times can sometimes be experienced in our clinic due to demands of our services; we appreciate your patience and understanding during these times.

If you have special dietary requirements, you should bring something to eat, we do have a small beverage bay and you are welcome to help yourself to tea, coffee and water. If you have any other special requirements or a particular disability please let the staff know so they can provide assistance.

What do I do when I arrive?

When you arrive at the clinic, check in at Reception and the staff will ask you to provide your valid Medicare card, your latest x-rays (images) and review the details you provided prior to your appointment. This includes information such as your name, address, phone number and General Practitioner details. You will also be asked to read and sign a consent form before seeing the doctor. The consent form refers to handling of your results, if you would be interested in being contacted about any of our research studies or whether you would like to receive invitations to educational events/information sessions in the future. All staff at the BCI adhere to the privacy and confidentiality policy of Western Sydney Local Health District (WSLHD). The WSLHD privacy policy is available at: www.wslhd.health.nsw.gov.au.

What happens at my first consultation?

When you are called to a consultation room, the doctor will take your health history, review your imaging and perform a breast examination. If you do not have a support person you may request a nurse as chaperone during your consultation and examination.

Following your initial consultation you will return to the waiting area while the team meets to discuss the findings of all new patients for the day. This meeting is called a multidisciplinary case conference and depending upon the number of new cases may take up to 2 hours.

If your doctor feels you need further mammography, ultrasound or a breast biopsy, this may be performed with your consent on the same day within BCI by a Breast Physician or Radiologist if available, or subject to available appointments you may be referred to an imaging centre externally.

You may be asked to complete a questionnaire and have clinical photography taken as part of our quality assurance program and for research purposes. Participation in this is voluntary.

What happens during the case conference?

During the case conference, your case will be discussed by your team. Your X-ray images will also be examined, and the best care plan for your situation will be developed based on the latest evidence and research. All cases are reviewed by at least three specialists during the multidisciplinary team case conference. This is a confidential process. Your clinical information remains private and is only shared with health professionals involved in your case management.

If you are leaving the clinic whilst the multidisciplinary meeting is on please check with the nurse first, to leave your mobile phone number.

Food and beverage outlets are available within the hospital. Tea, coffee and water is provided free of charge in the waiting room at the BCI. An SMS message will be sent to your mobile number if you have not returned by the time the case conference meeting is finished.

What happens after the case conference?

When the case conference has finished, you will be asked to return to the consultation room where a member of your team will talk to you about the recommendations discussed in the multidisciplinary meeting. Some people may require further tests or appointments to be arranged at this time. Where tests may need to be arranged at other facilities over the coming days, you will be asked to book another appointment at BCI to discuss the results.

If surgery is required, you will in most cases be given an operation date. A different doctor may see you after the case to discuss the recommendations and plan your management. A Breast Care Nurse will be introduced as your Case Manager. The Breast Care Nurse will see patients that are having surgery for breast cancer and in some cases other operations or tests.

The length of time that you have to wait depends on the availability of the doctor. We ask for your patience at this stage because the demands on individual doctors and nurses, is at times unpredictable. You may be seen out of order from your arrival appointment as the timing depends on the availability of the specialist you need to see.

Westmead Breast Cancer Institute participates in a number of clinical trials and research projects. You may be asked by a doctor or research nurse if you would like to participate.

At the conclusion of your consultations you will be given an appointment slip that has the necessary information for the reception staff. Please return to the Reception desk with your appointment slip(s) prior to leaving the clinic so that any future appointments can be made and to finalise your registration details.

If you require an appointment for either chemotherapy or radiation therapy, an appointment to see a specialist in that area to discuss recommendations and options will be made for you to attend at BCI or the Crown Princess Mary Cancer Centre Clinic the following week.

Where will I have my treatment?

Please note that in a public hospital, not all treatment will be performed by your specialist. However, all treatment is carried out under the Specialist Consultant’s guidance by trained members of their team. Where you have your treatment will depend upon your selection of hospital and the waiting times. If you wish to have treatment as a private patient please inform your treating team so this can be arranged. A number of our specialists do operate in Private Hospitals. Please inform the team if this is your preference.

Surgery

As a public patient your doctor may offer you surgery at either Westmead, Mt Druitt or Auburn public hospital dependent upon waiting times and availability.

If you have private health insurance, you may elect to have your surgery either at Westmead, Mt Druitt or Auburn public hospital as a private patient; or you may ask your surgeon for dates at a private hospital in the area.

Chemotherapy

After your initial consultation with a Medical or Radiation Oncology Specialist, appointments may be given for you to continue to see them at either Westmead Breast Cancer Institute, Crown Princess Mary Cancer Centre (both at Westmead), Blacktown Cancer Centre (Blacktown Hospital, Blacktown) or Nepean Cancer Centre (Nepean Hospital, Penrith) refer to the BCI website www.bci.org.au to view location maps.

Chemotherapy for public patients is offered across Westmead, Blacktown and Nepean Public Hospitals. At BCI we try to offer you treatment as close to your home as possible and within as short a timeframe as possible.

Some private hospitals offer chemotherapy day suites so if you have private health insurance you may ask your medical oncologist, if there is a private facility able to provide this service. Otherwise you can be referred to one of the public hospitals listed above.

Radiation Therapy

At present, all Radiation Therapy treatment is offered across Westmead, Blacktown and Nepean Public Hospitals, under one of our Radiation Oncologists. Appointments will be made in consultation with your Radiation Oncologist. Please ensure you speak to your specialist team or Breast Care Nurse for further information. A linear accelerator is used to give radiation treatment.

What happens after my first visit?

Future appointments may be booked before you leave. The next appointment may be your post-operative appointment or for results of further tests that may have been arranged. Sometimes it is just to go over things with you after you have had time to reflect on the information you have received. This may be after your surgery or to obtain the results from any further tests that were ordered during your initial visit. This visit could also take up to 2–3 hours.

Follow-up appointments are generally scheduled for later in the morning. Check in at Reception on arrival and inform staff if any of your personal details require updating.

A case conference is held before your next appointment, where your case will be reviewed. Consultations are scheduled to commence immediately after the case conference. The order in which you will be seen is based on which specialist you need to see.

After you have been called to the consultation room, you will be seen by the specialist or another multidisciplinary team member. Please be aware that because of time constraints, not all patients will be seen by the specialist consultant during their consultation. This will not affect the quality of care as the specialist consultant will supervise your care at all times.

The specialist or team member looking after you will provide you with information about your results and treatment plan options. You may need to see more than one specialist team (e.g. your surgical team, as well as the medical oncology team) and a Breast Care Nurse. This may occur on the same day or you may be referred to a specialist at another location such as the Crown Princess Mary Cancer Centre. Please return to Reception on your way out so that a follow-up appointment can be made for you if needed and to finalise your visit.

What happens next?

Every patient is unique and your treatment plan will be discussed with and tailored for you. Your treatment may include a combination of surgery, chemotherapy and radiation therapy. The specific treatment pathway for you will be explained at the next appointment after the case conference.

Once your treatment is complete, different specialists will review your case and provide advice about what ongoing care you will need. Your ongoing care will involve your General Practitioner or referring specialist, or a member of one of our specialist teams if required. Your Breast Care Nurse will provide you with treatment summary documentation and a discharge pack. If ever you have any concerns or questions feel free to contact your Breast Care Nurse as per the details at the end of this document. If your Breast Care Nurse is unavailable another Breast Care Nurse familiar with your case management will be available to assist.

The next follow-up appointment is usually made for you by the receptionist before you leave, based on information from the specialist.

Because of the large number of patients visiting the Breast Centre there is no guarantee your specialist consultant will personally see you at every follow-up visit. All doctors work together as part of our specialist team. The BCI operates within the public hospital system and all patients with a valid Medicare card are bulk-billed.

What do I need to bring to a follow-up clinic?

Patients who have had breast cancer will usually require an annual mammogram and ultrasound. You should bring any previous X-ray films or imaging and reports to your follow-up visit. You may be asked to complete further questionnaires and have clinical photography taken at your follow-up visits.

It is important that you advise Reception staff if your personal details have changed when you attend the clinic and please be aware you will be asked for your Medicare Card at each visit.

A new referral will be required every 12 months from your General Practitioner or every three months if it is provided by a specialist. The referral should specify the name of the specialist consultant supervising the clinic you are attending. You can ask your General Practitioner for an ‘indefinite’ referral, which will not need renewing.

Patients who have not had a cancer diagnosis will usually be referred back to their General Practitioner for further follow-up care and if over 50 you will be referred back to the BreastScreen NSW, program for a free mammogram every two years or annually if required by your specialist.

Your General Practitioner and your nominated specialists will receive correspondence regarding all of your treatment whilst under our care.

Other useful contact numbers

Breast Treatment Clinic: BCI-Clinic@health.nsw.gov.au (02) 8890 8888

Breast Assessment Clinic (Imaging): (02) 8890 5664

Pre-admissions: (02) 8890 7811

Crown Princess Mary Cancer Centre (02) 8890 5200

Cancer Council Connect 13 11 20 or www.cancer.org.au

Cancer Australia: canceraustralia.gov.au

Cancer Council www.cancer.org.au

Breast Cancer Network 1800 500 258 Australia (BCNA) bcna.org.au

Visit us at www.bci.org.au for information about breast cancer and access to all of our brochures and educational resources.

This information guide is also available in PDF format to download.

Version 2 – WSP 140 July 2024

Welcome to Westmead Breast Cancer Institute