P1-11-09: Effects of a Multidisciplinary Breast Cancer Clinic in an Appalachian Based Medical Center.

Abstract

Abstract Background: Adena Health System is a not for profit 250 bed institution that provides health care for a 13 county region in southeast, Appalachia Ohio. Access to health care in rural setting is an ongoing challenge. Several barriers to health care access affect this region. Socioeconomic burden and lack of higher education are two of the most dominant barriers. The age-adjusted beast cancer rates are 5.3% higher in the Appalachian region and the stage at presentation is more advanced. In December of 2009, we held our first Multidisciplinary Breast Cancer Clinic (MDBCC). The goal of the MDBCC is to facilitate prompt diagnosis and effective treatment. The MDBCC is staffed by a team of physicians consisting of surgeons, medical oncologists, and radiation oncologists. The team meets with the patient in a one on one setting. That same day the patients are discussed by the team with input from pathology and radiology in order to tailor a treatment plan specifically for each patient. After the conference, the recommendations are discussed with the patient before treatment is initiated. Material and Methods: In a retrospective review, we evaluated the effect of a MDBCC on days to diagnosis, days from diagnosis to treatment, percentage of patients receiving neoadjuvant chemotherapy, and stage at diagnosis. Since December 2009, there have been over 90 breast cancer patients evaluated in the MDBCC. We randomly selected 60 breast cancer patients treated prior to MDBCC between 2008–09 and 66 patients evaluated at the MDBCC between December 2009–2011 from the tumor registry database. Results: The average number of days to diagnosis pre-MDBCC was 15.5 days as compared to 4 days post-MDBCC. In 2008–09, the average days to treatment (pathology result to a-port placement, surgery or chemotherapy) was 18 days as compared to 12 days post-MDBCC. The percentage of patients receiving neoadjuvant chemotherapy has not changed significantly, however, there is an upward trend approaching statistical significance (10% per-MDBCC vs. 12% post-MDBCC). The stage at presentation has not changed significantly since the start of the MDBCC. Discussion: The development of the MDBCC has proven to be a successful team oriented approach to breast cancer diagnosis and treatment. Time to diagnosis and initiation of treatment has improved. Providing patients with access to multiple specialists and forming a treatment plan the same day improves quality of care and lessens economic burden. The MDBCC is clearly feasible and particularly suited to the rural hospital setting. System wide, we hope to see a decrease in the stage at presentation and are confident based upon our current data that this in a realistic goal. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-11-09.