A tracking and feedback registry that enhances completed oncology consultations between surgeons and oncologists also appears to reduce rates of adjuvant treatment underuse and to eliminate the racial disparity in treatment.

No abstract

Background: Despite the existence of effective adjuvant treatment for early stage breast cancer, women do not always receive it, particularly, minority women. Primary treatment for breast cancer, surgery and varying combinations of radio-, chemo- and hormonal therapy, is delivered by different specialists and is often fragmented. Underuse of post-surgical adjuvant treatment occurs more commonly among women who do not see a medical oncologist despite surgeons’ referral request. To reduce underuse of adjuvant treatment due to failed connections, we tracked and fedback to surgeons information about whether their newly diagnosed breast cancer patients connected with an oncologist. Methods: We compared oncology referral rates and underuse among pre-intervention (N=677) and intervention (N=300) patients undergoing breast cancer surgery at 6 NYC hospitals. All surgeons consented to the intervention. Each surgeon chose an office person to verify eligibility and identify patient’s oncology referrals. Patients identified upcoming oncology appointment sites and times. Following scheduled visits, oncologists were called to verify patients’ connection & these data were fedback to surgeons & their office staff. Six months later, we abstracted in- & outpatient charts. We compared rates of: completed oncology consultations and underuse of radiotherapy after breast conserving surgery, of chemotherapy for ER negative and hormonal therapy for ER positive tumors >1cm between pre- and intervention women with newly diagnosed early-stage breast cancer. Results: There was a significant increase in oncology consultations completed (83% to 97%; p<0.0001) and decrease in underuse of adjuvant treatment (21% to 14%; p<0.001); specifically, underuse of chemotherapy (22% to 11%; p=0.05) and hormonal therapy (20% to 8%; p=0.0004) declined. Among black and Hispanic women, underuse of radiotherapy significantly decreased (23% to 10%; p=0.02). Multivariate models, adjusting for clustering by hospital, patient age, race, stage and insurance, found the intervention increased rates of oncology consultation (OR=5.33; 95%CI: 2.68-10.60), and reduced adjuvant underuse (OR= 0.62; 95%CI: 0.42-0.93). Minority race was no longer a risk factor for an oncology consultation (OR=1.20; 95%CI: 0.69-2.08) or underuse of adjuvant therapy (OR= 1.13; 95%CI: 0.73-1.75). Conclusions: A tracking and feedback registry which closes the referral loop between surgeons and oncologists appears to improve rates of medical oncology consultation, reduces rates of adjuvant treatment underuse and eliminates the racial disparity in treatment.

Sjogren's syndrome (SS) is an autoimmune disorder characterized by the destruction of exocrine glands by lymphocytic infiltration. Children and teenagers are less commonly affected. The initial symptoms of SS in teenagers might vary, depending on whether parotitis or other systemic organ involvement is present. Glandular involvement with the clinical hallmarks of dry eyes and dry mouth is common. Our case report is about a young woman who was admitted with acute flaccid paralysis and severe respiratory distress with extremely low serum potassium; further investigation revealed distal renal tubular acidosis. The patient was ultimately diagnosed with primary SS with high levels of SS-a/SS-b antibodies and a positive Schirmer's test. Our case demonstrates that hypokalemic paralysis can be a manifestation of SS, even though it is a rare cause.