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Patterns of multidisciplinary care in the management of non-metastatic invasive breast cancer in the United States Medicare patient
Breast Cancer Res Treat. 2016 Nov;160(1) :153-162
PMID: 27640196    PMCID: PMC5064835    URL: http://www.ncbi.nlm.nih.gov/pubmed/27640196
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PURPOSE: Multidisciplinary care (MDC) in managing breast cancer is resource-intensive and growing in prevalence anecdotally, although care patterns are poorly characterized. We sought to determine MDC patterns and effects on care in the United States Medicare patient. METHODS: Patients diagnosed with non-metastatic invasive breast cancer from 1992-2009 were reviewed using the Survival, Epidemiology, and End Results (SEER)-Medicare linked dataset. MDC was defined as a post-diagnosis, preoperative visit with a surgical, medical, and radiation oncologist. Same-day MDC (MDCSD) was the MDC subset having all three visits on one date. RESULTS: Among 88,865 patients, MDC was utilized in 2.9 %, with 14.1 % of these having MDCSD. MDC use did not vary by stage, but MDC patients were more likely to be younger, black, receive lumpectomy, have fewer nodes examined, and receive radiotherapy. MDCSD patients were more likely than non-MDC patients to be black, receive mastectomy, and receive radiotherapy. MDC and MDCSD use increased over time and varied by geographic region, with rural patients less likely to receive MDC (OR 0.54 [95 % CI 0.45-0.65]) and MDCSD (OR 0.32 [95 % CI 0.19-0.54]). Radiotherapy after breast conserving surgery, used in 86.5 % of non-MDC patients, was administered to 90.2 % of MDC (p = 0.001) and 92.6 % of MDCSD (p = 0.019) patients. Post-mastectomy radiotherapy was administered in 52.0 % of non-MDC patients, 63.8 % of MDC (p = 0.050), and 89.1 % of MDCSD (p = 0.298) after propensity score adjustment. CONCLUSION: While increasing, few Medicare patients undergo MDC and MDCSD is rare. MDC may improve quality and MDCSD should be considered for patient convenience. While not yet widespread, efforts should integrate MDC and MDCSD across the U.S.
Churilla, Thomas M Egleston, Brian L Murphy, Colin T Sigurdson, Elin R Hayes, Shelly B Goldstein, Lori J Bleicher, Richard J ENG P30 CA006927/CA/NCI NIH HHS/ Netherlands 2016/09/19 06:00 Breast Cancer Res Treat. 2016 Nov;160(1):153-162. Epub 2016 Sep 17.