Preoperative triage and multidisciplinary consultation for patients with breast cancer: A pilot study between surgery and medical oncology.

Abstract

208 Background: Breast cancer management has become exceedingly collaborative across specialties. Preoperative multidisciplinary input in particular is increasingly needed as indications for neoadjuvant therapy (NAT) continue to expand. In British Columbia, as in many other regions, breast cancer surgery is typically performed by community surgeons working in settings away from medical and radiation oncologists, making preoperative multidisciplinary input challenging. Methods: This prospective pilot study was designed to enhance and streamline preoperative breast cancer care at the BC Cancer Agency Vancouver Centre (BCCA) and Mount Saint Joseph’s Hospital (MSJ). Patients with a new diagnosis of breast cancer at the MSJ Breast Clinic are included in this pilot triage project if tumors meet one or more of the following criteria: triple negative, HER2+, clinically palpable ≥ 2cm, or present with positive/palpable nodes. Before the patient has consulted with a surgeon, the pathology, imaging, and GP’s assessment is faxed by a MSJ nurse navigator to BCCA for preoperative triage by a medical oncologist. A BCCA navigator facilitates this confidential electronic triage process, and communicates the medical oncologist’s recommendation [a) urgent referral for NAT, or b) upfront surgery] back to MSJ for appropriate booking and management. Results: Since inception in November 2014, 42 patients have undergone electronic preoperative triage through this pilot project. Of those, 47.6% were recommended to have, and did have, a preoperative medical oncology consult to discuss NAT. 90% of patients who had a NAT consult ultimately received NAT compared to a 66% uptake of NAT through the traditional referral process (P = 0.029). Median wait time from ‘biopsy result’ to ‘start of chemotherapy’ was significantly reduced by 9 days through this novel triage process (P = 0.047). Conclusions: This preoperative multidisciplinary triage project has significantly reduced treatment wait times and improved patient selection for and uptake of NAT for breast cancer. Breast cancer care benefits from increased preoperative navigation to help streamline and expedite care for high-risk patients.