Multi-disciplinary pre-therapeutic consultation significantly improves management of breast cancer patients.

Abstract

Abstract Abstract #6151 Introduction
 Modern therapeutic management of breast cancer requires a multidisciplinary approach. Since 2001, the Geneva University Hospitals has set up a pre-therapeutic consultation (COSP) involving gynaecologists, medical oncologists, radiation therapists, as well as radiologists, pathologists, plastic surgeons, and nurses. The COSP team discusses and provides therapeutic recommendations for newly diagnosed breast cancer patients seen in our institution. This study evaluates the impact of COSP on patient's management.
 Patients and methods
 Between 2001-2005, 1771 patients had breast cancer diagnosis among the resident population: 750 patients were referred to the COSP and 1021 were not. We compared patients and tumours characteristics between these two groups by logistic regression. We compared concordance between initial proposed therapeutic option and final COSP treatment recommendation by heterogeneity test. Changes in treatment were considered as major if they concerned type of surgery, or the addition of systemic neo-adjuvant treatments. Other changes were coded as minor. Trend tests were calculated to evaluate management changes over time.
 Results
 Patients referred to the COSP were significantly younger, more often of low socio-economic status, foreigners, divorced, and treated in public sector. They were less frequently diagnosed through screening, and had more advanced stage at diagnosis. Complete initial treatment recommendation was available for 654 patients. For 109 (17%) patients, COSP dramatically changed the initial therapeutic propositions. For 169 (26%) patients, COSP proposed only minor changes. Among patients referred to the COSP, we observed a significant increase of immediate reconstructive surgery (p<0.001) and an increase of standard treatment options for women aged 80 years or more (p<0.001). Similar changes were absent among patients not referred to the COSP.
 Conclusion
 The multi-disciplinary pre-therapeutic consultation provides important changes in initial treatment options in routine health care practice. In particular it improves reconstruction and generalisation of good practices in elderly patients. This approach should become a gold-standard in the management of all breast cancer patients. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6151.