Abstract P5-13-14: Factors associated with multidisciplinary care in the management of early stage breast cancer

Abstract

Introduction: In patients with early stage breast cancer (BC) treated with curative intent, multidisciplinary teams (MDT) have emerged as a way to involve a wide range of specialists and encourage effective communication to formulate an optimal treatment strategy for patients. We sought to evaluate the frequency and predictors of MDT evaluation in patients with BC. Methods: We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked dataset to evaluate patients diagnosed with stages I and II breast cancer who underwent primary surgery from 2002-2007 and were followed through 2012. We evaluated claims for outpatient visits and characterized the treating physician as a surgeon, radiation oncologist (RO) or medical oncologist (MO). We defined MDT as having seen a physician in each of the three specialties within 12 months of diagnosis. We used multivariable logistic regression to evaluate factors associated with MDT. Results: A total of 35,484 stage I and II breast cancer patients were included in the analysis. Within the first year, 77.5% visited a medical oncologist, 57.8% visited a radiation oncologist, and 47% of women were seen by all 3 specialists. Prior to surgery, 4.9% of patients were seen by all 3 physicians, with 14.8% seen by a MO and 16.4% seen by a RO in addition to the surgeon. Evaluation by a MDT was more frequent in women who had a lumpectomy vs mastectomy (57.1% vs 28.4%, p<0.0001), Caucasian race as opposed to black and Hispanic (47.4% vs 42.1% vs 37.4%, p<0.0001), those that lived in an urban setting versus rural (48.1% vs 36.25%, p<0.0001), and those that were married versus unmarried (50.8% vs 43.1%, p<0.0001). As age increased, the number of patients who saw all three physicians decreased. As socioeconomic status improved, more patients saw all three physicians. In a multivariate model, evaluation by a MDT was higher in patients with Stage II disease (OR [95% CI] = 1.10 [1.04-1.18]), diagnosed in 2006-2007 (as compared to 2002-2005) (OR = 1.73 [1.63-1.85]), and those who received chemotherapy (OR = 1.51 [1.39-1.64]) and was less likely for older women (OR = 0.77 [0.71-0.84]), those who underwent mastectomy (OR = 0.73 [0.68-0.78]), and those in the lowest socioeconomic quintile (OR = 0.88 [0.80-0.97]). Of those seen by all 3 physicians in the first year, 20.4%, 10.1%, 6.1%, and 3.9% were seen by all 3 specialists in years 2, 3, 4 and 5 respectively. Only 2.2% of patients saw all three specialists all five years. Conclusions: Early stage breast cancer patients are evaluated by a medical oncologist, surgeon and radiation oncologist less than 50% of the time in the first year after diagnosis. Prior to surgery, where decision making may be most important, only 5% of patients were evaluated by all three specialties. Further research is needed to determine if MDT improves quality of care delivered, treatment adherence, patient satisfaction or breast cancer survival. Citation Format: Quyyumi F, Accordino MK, Buono DL, Neugut AI, Hillyer GC, Wright JD, Hershman DL. Factors associated with multidisciplinary care in the management of early stage breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-13-14.