Abstract P1-05-02: Reducing Delays of Breast Cancer Care Using An Innovative Digital Health Platform

Abstract

Abstract Background: For breast cancer patients, prolonged time from core needle biopsy to initiation of treatment is associated with an incremental decrease in overall survival. This overall survival reduction disproportionately affects patients with stage I and II breast cancer (hazard ratio: 1.09-1.16, p< 0.001), the subgroup of breast cancer patients for which a survival reduction would be least expected due to its early stage and least accepted due to its large population size and potential increased cost of healthcare. Materials and Methods: We conducted an IRB-approved quality improvement initiative among patients with Medicare Advantage at a large integrated healthcare organization in Nevada to assess the ability of an innovative digital health platform to reduce the time interval between positive core needle biopsy to initiation of breast cancer treatment compared to a historical cohort of Medicare Advantage patients diagnosed and treated at the same facility over the preceding 6-month period. The study was restricted to women evaluated at a single contracted breast imaging center for inconclusive (Bi-RADS 0) and suspicious (BI-RADS 4 & 5) mammograms, ultrasound, and/or breast MRI. Time to treatment (TTT) calculations were limited to the subset of patients diagnosed with in situ and invasive breast cancer by core needle biopsy. The primary goal was to reduce the historical TTT by greater than 50%. A secondary goal was to reduce TTT to < 30 days, well below the interval where overall survival would be adversely affected. Results: Between September 2021 and April 2022, 552 patients with BI-RADS 0, 4, and 5 breast imaging were enrolled in the quality improvement initiative and managed on the XpediteMD digital health platform. 208 patients were designated as BI-RADS 4 or 5 (i.e., suspicious imaging findings), all of whom ultimately underwent a diagnostic core needle biopsy. Of these, 75 patients were found to have invasive or in situ breast cancer and were subsequently referred to surgery or medical oncology where treatment was initiated. Among these patients, average TTT was 32 days with use of the digital health platform compared to 74 days in the historical cohort, a statistically significant 57% reduction in TTT, exceeding the 50% TTT goal. Although the study did not meet the target goal of average TTT < 30 days from needle biopsy to initiation of treatment, failure to achieve this goal was largely attributable to 3 patients who elected to delay cancer therapy for personal or health reasons. Excluding these 3 patients would have yielded an average TTT of 28.75 days, which is within our < 30-day goal. Conclusions: This quality improvement initiative demonstrated the successful deployment of a novel digital health platform which achieved a 57% reduction in the time interval from a positive core needle biopsy to performance of breast cancer surgery or initiation of systemic therapy. By reducing TTT to 32 days, the initiative eliminated any delay in initiation of cancer therapy that could have compromised patients’ overall survival. Citation Format: Dennis R. Holmes, Riya Pulicharam. Reducing Delays of Breast Cancer Care Using An Innovative Digital Health Platform [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-05-02.