BREAST SURGICAL ONCOLOGIST, SR PHYSICIAN Ochsner Clinic Foundation, United States
Objectives: Invasive breast cancer often utilizes multidisciplinary strategies for management. Multidisciplinary clinics (MDC) were created at high-volume surgical oncology centers to optimize care, in which patients are seen by multiple sub-specialists at one visit. The efficacy of MDC has been difficult to quantify in the literature due to variance amongst teams, timing delays, and differences in targeted outcomes.
Methods: We conducted a retrospective chart analysis of 492 patients with invasive breast cancer from Jan 1, 2020 to September 1, 2022. Patients seen in clinic by a breast surgeon, medical oncologist, and radiation oncologist were included. Patients seen at our MDC were selected into the experimental cohort. Patient demographic data was examined and patients were subdivided by type of breast cancer, date of diagnosis, date of clinic visit, and date of first intervention (either surgery or chemotherapy). Patients were excluded if they did not complete care at our institution, or did not have invasive breast cancer. We hypothesize the time interval from biopsy to intervention is shortened by consolidating separate subspecialty visits into a MDC.
Results: Population demographics include 490 females and 2 males, with a median age of 63. MDC group included 37 patients. Subtypes of breast cancer include 328 invasive ductal carcinoma, 73 invasive lobular carcinoma, 1 malignant phyllodes, and 89 invasive mammary carcinoma. Average tumor size was 1.7 cm with a median histologic grade of 2. There were 55 patients with triple negative breast cancer, 275 estrogen receptor positive cancer, and 51 HER2neu receptor positive cancer. Fifty-four patients presented with biopsy-proven lymph node involvement at initial consultation. Ninety-seven patients underwent neoadjuvant chemotherapy, 163 patients completed adjuvant chemotherapy, and 169 patients completed radiation therapy.
Mean time from biopsy to surgery clinic visit is 13 days across all patients, versus 10 days for MDC patients. This difference is statistically significant [t Sat > t critical two tail: 2.09 > 1.99]. Mean time to chemotherapy is 28 days for all patients versus 23 days in MDC patients, which is statistically significant [t Sat > t critical two tail: 5.12 > 2.019]. Mean time from clinic to surgery is 45 days for all patients versus 24 days in MDC patients [t Sat > t critical two tail: 6.63> 2.00].
Conclusion: Although early in our experience, we have shown that our multidisciplinary approach to breast cancer care significantly decreases time to intervention, either surgery or chemotherapy. Future directions include meta-analysis to explore patient outcomes and survival.
