Improving Quality in Breast Cancer Treatment

Objectives: The goal of this study is to evaluate and compare care received following implementation of the multidisciplinary care tumor board at a community hospital in Detroit, MI. Methods: This is a retrospective chart review of patients who were newly diagnosed with invasive breast cancer one year prior to and one year following the implemenation of the MDC tumor board. Demographic information including race, age, insurance type (private vs public) and hospital site (urban vs suburban) where treatment was received was obtained. Additionally, stage at diagnosis, hormone receptor (HR) status, eligibility for and receipt of breast conserving treatment, neoadjuvant chemotherapy, hormonal therapy, radiation therapy, adjuvant chemotherapy, fertility sparing counseling, oncotype testing and genetic counseling was also obtained. SPSS was used for multivariate analysis. Significance was determined to be p\u3c0.05. Results: A total of 539 patients were eligible for the study. Average age of women in the MDC group was 62 years vs. average age of women in the non-MDC group of 59 years. The racial make up included 57% white, 43% black. There was no significant difference between eligibility and receipt of neoadjuvant chemotherapy, breast conserving therapy, endocrine therapy, radiation therapy or adjuvant chemotherapy in patients who were treated prior to the implementation of the MDC tumor board as compared to those receiving treatment after the implementation of the MDC tumor board. However, there was a significant difference in the frequency of oncotype testing and fertility counseling offered to patients who were diagnosed after the MDC was implemented. In a subset analysis, there was a significant difference in the receipt of breast conserving therapy in black women irrespective of participation in the multidisciplinary group (p=0.016). In fact, all women who received care at the urban facility were less likely to receive breast-conserving therapy (p=0.009) and were less likely to receive and be offered chemotherapy or Herceptin. Conclusions: While the Multidisciplinary care tumor board implementation has not yet established a significant difference in receipt of cancer care among all women, the ability to offer eligible patients fertility counseling and oncotype testing has improved significantly.https://scholarlycommons.henryford.com/merf2019qi/1014/thumbnail.jp