Abstract P5-09-03: Education and integration of medical breast nurse practitioners in a multidisciplinary breast cancer program

Abstract

Abstract Background: Work-up of patients with breast symptoms and radiographic abnormalities, risk management, and survivorship care are vital elements in a multidisciplinary breast cancer program. Breast surgeons have traditionally provided for these needs, but with intense clinical demands and with efforts to reduce treatment time, access for patients with these problems can be a challenge. The medical breast specialist (MBS) is defined as a primary care physician who has been provided with additional training in benign and malignant breast disease [Smedira, AIM 2008]. With increasing need for providers, a fellowship for training MBS was designed for board eligible or board certified internists, family practitioners, obstetricians/gynecologists, and has recently been expanded for board certified primary care nurse practitioners, one of the first of its kind in the country. In our practice, medical breast visits (MBV) are defined as clinical visits for evaluation or follow-up of patients with breast symptoms, high risk management, and/or survivorship. Methods: The MBS Program at our institution was established in 1997, with expansion involving a formalized training for Nurse Practitioners in 2013. The medical breast fellowship uses a defined curriculum and offers nurse practitioners a six month multidisciplinary program with multiple rotations including medical breast clinic, surgical breast clinic, breast imaging, medical oncology, radiation oncology, genetics, pathology, plastic surgery, physical therapy, and psych-oncology. We analyzed the impact of trained NPs on overall medical breast and breast center volumes and clinical workflow. Our prospectively maintained Electronic Medical Records (EMR) system, which allows the acquisition of volume and practice pattern data, was utilized for this analysis. Results: The number of MBV has significantly increased between 2008 and 2014 (p<0.05). MBV accounted for 54% of total visits seen within the breast surgery program in 2014. The total number of medical breast visits in 2014 was 7146 with 5543 (78%) seen by MBS and 1603 (22%) seen by surgeons. Of the medical breast visits seen by MBS, 37% are seen by medical breast staff physicians and 63% are seen by medical breast nurse practitioners. The recent completion of the medical breast fellowship by a NP resulted in the addition of 1654 MBV over the course of 1 year. Conclusions: Medical breast visits account for a large percentage of patients seen within a multidisciplinary breast cancer program. The development of a curriculum for training NP medical breast specialists enables the rapid incorporation of a NP into a multidisciplinary cancer program. The training of a NP within the fellowship can increase patient access, timeliness of care, and can facilitate streamlining of a breast cancer practice to optimize patient care. Citation Format: Iyer PH, Kline M, Oliphant D, Crowe J, Grobmyer S, Pederson H. Education and integration of medical breast nurse practitioners in a multidisciplinary breast cancer program. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-09-03.