No abstract

The elderly are a growing surgical population with more comorbidities and less physiological reserve compared with nonelderly patients. The objective of our study was to implement a quality improvement pilot program targeting the specific needs of the elderly. We prospectively enrolled consecutive patients aged 65 years or older undergoing inpatient general or vascular surgery operations. Patients completed a preoperative assessment including the Vulnerable Elder Survey (VES) to determine baseline functional status and incidence of polypharmacy (five or more medications). They were interviewed postdischarge Day 2 and Day 30 for changes in functional status. An intervention was implemented consisting of an elderly-specific postoperative order set and preoperative risk reports sent to the surgical team with instructions to order physical therapy consults and home health nursing on discharge for VES 3 or greater and geriatrics consults for patients with polypharmacy. The elderly-specific order set was used for 71 per cent of the post-intervention group. There were no differences in the percentage of participants receiving physical therapy, geriatric, or home health nursing consults between the two groups. The postintervention group had significantly better functional status on postdischarge Day 30 ( P < 0.01). Our preliminary data suggest that individualizing care for elderly patients is feasible and may improve postoperative outcomes.

Optimal preoperative patient selection for NSM and intraoperative assessment of the NAC result in acceptably low rates of NAC involvement/recurrence. NSM alone is not adequate justification for post-mastectomy radiation. NSM should be taken into consideration to inform radiation decision making only when preoperative imaging, clinical features, or pathologic findings suggest higher risk for NAC involvement.

Phyllodes tumors of the breast are rare fibroepithelial tumors that are characterized as benign, borderline, or malignant based on cellular characteristics such as stromal overgrowth and number of mitoses. Currently, there is a lack of consensus on risk factors and management of patients with phyllodes tumors, which has led to variation in treatment patterns as well as patient outcomes across many institutions. This study seeks to understand the clinicopathologic features, risk factors for local and metastatic recurrence, and clinical outcomes of patients with phyllodes tumors to better define optimal treatment patterns.

This report shows substantially higher FH documentation and appropriate genetic testing rates than prior reports. Many patients with indications for genetic testing may have only FH-based indications for testing, and this subset may account for the sizable proportion of patients with newly diagnosed BCa who have actionable mutations.

124 Background: After recent implementation of a multidisciplinary breast clinic (MDC) for newly diagnosed women at our institution, we sought to examine the impact of MDC on patient satisfaction, timeliness and guideline concordant care. Methods: Women with newly diagnosed breast cancer at our institution are referred to MDC where they are seen by a team of breast specialists for initial consultation. The MDC model is further facilitated by a patient navigator/coordinator who serves as a single point of contact across disciplines and through the continuum of care. We deployed patient satisfaction surveys querying helpfulness of the care coordinator and satisfaction with seeing breast cancer specialty physicians together in one visit. We further retrospectively analyzed timeliness of care and guideline concordant care since MDC implementation. Results: Patient satisfaction survey response rate was 42% (n=133).On a scale of 1 (very poor) – 5 (excellent), 93% of respondents rated helpfulness of care coordinator as excellent and seeing specialty physicians together in one visit as excellent. 99% of respondents rated these factors as either excellent (5) or good (4). Regarding timeliness, among 202 women with newly diagnosed, non-metastatic breast cancer seen in MDC between June 2012 and April 2014, mean time from neoadjuvant chemotherapy to surgery was 43.1 days (range 26-78 days), from surgery to adjuvant radiation was 39.2 days (range 22-79 days), from surgery to adjuvant chemotherapy was 40.6 days (range 19-89 days), and from adjuvant chemotherapy to radiation was 34.9 days (range 13-67 days). All timeliness metrics well exceeded established national standards of 60-90 days. Regarding guideline concordant care, 94% and 90% respectively received indicated radiation therapy and chemotherapy in accordance with National Comprehensive Cancer Network (NCCN) Guidelines. Those not receiving guideline concordant care either declined, were of advanced age, or had prohibitive co-morbidities. Conclusions: The MDC model, which emphasizes care coordination via a team approach and patient navigation, is associated with excellent patient satisfaction and timely, guideline concordant breast cancer care.

Background Mastectomy rates, both therapeutic and prophylactic, are on the rise in the United States. After recent implementation of a multidisciplinary breast clinic for newly diagnosed women at our institution, we sought to examine the impact of multidisciplinary care on surgical decision making. Materials/Methods Women with newly diagnosed breast cancer at our institution are referred to a multidisciplinary breast clinic where they are seen by a team of breast specialists (MDC) or to an individual practitioner (non-MDC) for initial consultation. We retrospectively analyzed rates of breast conserving surgery (BCS) and mastectomy among women with newly diagnosed breast cancer seen in either setting. For mastectomy cases, we designated the mastectomy as clinically indicated vs not clinically indicated based on National Comprehensive Cancer Network (NCCN) guidelines for breast conservation. T-test and chi-square were used to examine the comparability between MDC and non-MDC cohorts. Logistic regression was used to evaluate the overall prevalence of BCS among MDC and non-MDC cohorts. Stratification analysis was further conducted to examine BCS rates among women in each cohort receiving neoadjuvant chemotherapy vs up front surgery. Results A total of 341 consecutive patients were analyzed, including 202 MDC and 139 non-MDC patients seen in initial consultation between June 2012 and April 2014. The MDC and non-MDC cohorts were statistically equivalent in terms of age, tumor and nodal stage, histology, biomarker status, receipt of neoadjuvant chemotherapy, and proportion with genetic mutations. In the MDC cohort, 66% underwent BCS vs 42% in the non-MDC cohort (p&lt;0.0001). Of those receiving neoadjuvant chemotherapy, 37% in the MDC cohort underwent BCS vs 12% in the non-MDC cohort (p=0.08). Of those proceeding to surgery without neoadjuvant therapy, 70% underwent BCS in the MDC cohort vs 46% in the non-MDC cohort (p&lt;.0001). Among mastectomies performed in the MDC vs non-MDC cohorts, 77% and 41% respectively were clinically indicated (P&lt;.0001). Rates of unnecessary contralateral prophylactic mastectomy were comparable in both groups, 39% (p=0.99). Conclusions Breast cancer patients seen in an MDC setting at the time of initial diagnosis are significantly more likely than women seen in a non-MDC setting to undergo breast conservation. We hypothesize that the MDC model of breast cancer care, via facilitation of more informed medical decision making, may be a viable strategy to curtail rising mastectomy rates in the United States. Citation Format: Caitlin L Gomez, Pin-Chieh Wang, Nicole A Dawson, Robyn L Dvorak, Nova Foster, Anne Hoyt, Sara A Hurvitz, Amy Kusske, Charles Y Tseng, Susan A McCloskey. Multidisciplinary breast cancer care is associated with a higher rate of breast conservation in comparison with non-multidisciplinary care [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-16-02.

45 Background: Approximately 5% to 10% of women diagnosed with breast cancer have a genetic predisposition, which can affect management recommendations. The National Comprehensive Cancer Network (NCCN) has established guidelines for genetics referral and testing, however recent publications have indicated low rates of family history documentation and appropriate genetics referral. We sought to assess the impact of standardized family history documentation on rates of appropriate genetics referral in a multidisciplinary breast clinic (MDC) setting. Methods: In advance of MDC consultation, women with newly diagnosed breast cancer complete an intake questionnaire which includes documentation of Ashkenazi Jewish ancestry along with a thorough family history. We retrospectively analyzed family history documentation to inform eligibility for genetic testing and rates of appropriate genetics referral. Results: Between June 2012 and April 2014, 202 women with newly diagnosed, nonmetastatic breast cancer were seen in MDC. We noted 100% compliance with family history documentation. Per NCCN Guidelines, genetic testing was indicated in 52% (106 patients), of which 77% were appropriately referred to a genetic counselor for evaluation. All patients who met criteria based on personal history factors including age ≤ 45, triple-negative disease under age 60, or two or more breast primaries under age 50 were appropriately referred. Patients who were eligible but not referred ranged in age from 46 to 93 and were eligible for testing based on Ashkenzi Jewish ancestry (3 patients) or family history factors including a relative with ovarian cancer (3 patients), ≥2 relatives with breast cancer (5 patients), or a relative with breast cancer < age 50 (7 patients). Conclusions: Compared with recently published national averages, rates of appropriate family history documentation and genetic testing referrals are significantly higher in our MDC setting. However, this analysis has identified significant opportunity for improvement via identification of overlooked referral indications. Initiatives are underway to improve future compliance.