Multidisciplinary Breast Cancer Care Research Articles

Erratum: National Healthcare Provider Assessment of Guideline Adherence and Multi-disciplinary Breast Cancer Care in Nigeria: A Call for Action.

Erratum: National Healthcare Provider Assessment of Guideline Adherence and Multi-disciplinary Breast Cancer Care in Nigeria: A Call for Action.

National Healthcare Provider Assessment of Guideline Adherence and Multi-disciplinary Breast Cancer Care in Nigeria: A Call for Action

PURPOSE The Nigerian Federal Ministry of Health (FMOH) endorses National Comprehensive Cancer Network (NCCN) Harmonized Guidelines for sub-Saharan Africa (SSA) for breast cancer (BC), which were developed with the African Cancer Coalition and resource adapted for SSA. The FMOH advocates for multi-disciplinary tumor boards. This research aimed to better understand guideline awareness, adherence among specialties and multi-disciplinary care as a basis for an implementation plan. METHODS Guided by the Consolidated Framework for Implementation Research (CFIR), a multi-national, multi-disciplinary team developed a healthcare provider (HCP) questionnaire to evaluate guideline-adherent BC care practices. HCPs in Nigeria were recruited electronically through society distribution lists and snowball sampling from November 2023–January 2024. Results were analyzed using descriptive statistics and univariate logistic regression. RESULTS Participants (n=277) included: surgeons (n=124, 45%), radiologists (n=59, 21%), clinical oncologists (n=49, 18%), and pathologists (n=45, 16%). HCPs had a median 7(IQR 3-12) years in practice and devoted an estimated 30% (IQR20-50) of their practice to breast healthcare. 79% (n=217/274) practiced in a teaching hospital. Only 38% (n=103/273) reported structured multi-disciplinary discussion at their institution. 92% (n=253/274) of HCPs believe BC guidelines contribute to better patient outcomes and 51% (n=100/195) routinely consult guidelines in practice. However, 69% (191/277) reported insufficient resources to routinely provide guideline-adherent care and 46% (122/266) regularly adjust clinical recommendations based on patients’ ability to follow them. NCCN guidelines were most cited, but only 34% (93/277) were aware of FMOH-endorsed Harmonized Guidelines. Clinical oncologists were 5-times more likely than surgeons (OR-0.20, 95% CI: 0.09, 0.42), and 20- and 50-times more likely than pathologists (OR-0.05, 95% CI: 0.02, 0.14) or radiologists (OR-0.02, 95% CI: 0.01, 0.06), respectively, to consult guidelines regularly. Completing a cancer-related fellowship, devoting more time to breast healthcare, and receiving additional BC training were associated with consulting guidelines. 70% (195/277) of HCPs identified a need for additional education/training in BC care. HCPs who regularly engage in multi-disciplinary discussion were more likely to consult guidelines (OR-2.60, p=0.030). To ensure delivery of guideline-adherent care, 83% (230/277) reported needing greater access to multi-disciplinary discussion. CONCLUSION A major gap exists between FMOH recommendations and current practices in BC guideline utilization and multi-disciplinary care. Structured multi-disciplinary discussion can provide a forum for promoting awareness of resource-compatible Harmonized Guidelines, sharing knowledge across provider-types, and developing resource-appropriate patient care plans.

Proton Reirradiation for High-Risk Recurrent or New Primary Breast Cancer.

Radiotherapy is an integral component of multidisciplinary breast cancer care. Given how commonly radiotherapy is used in the treatment of breast cancer, many patients with recurrences have received previous radiotherapy. Patients with new primary breast cancer may also have received previous radiotherapy to the thoracic region. Curative doses and comprehensive field photon reirradiation (reRT) have often been avoided in these patients due to concerns for severe toxicities to organs-at-risk (OARs), such as the heart, lungs, brachial plexus, and soft tissue. However, many patients may benefit from definitive-intent reRT, such as patients with high-risk disease features such as lymph node involvement and dermal/epidermal invasion. Proton therapy is a potentially advantageous treatment option for delivery of reRT due to its lack of exit dose and greater conformality that allow for enhanced non-target tissue sparing of previously irradiated tissues. In this review, we discuss the clinical applications of proton therapy for patients with breast cancer requiring reRT, the currently available literature and how it compares to historical photon reRT outcomes, treatment planning considerations, and questions in this area warranting further study. Given the dosimetric advantages of protons and the data reported to date, proton therapy is a promising option for patients who would benefit from the added locoregional disease control provided by reRT for recurrent or new primary breast cancer.

Lessons learned from COVID-19: improving breast cancer services from the patient perspective

Abstract Globally, health services for breast cancer (BC) were significantly disrupted due to the coronavirus disease (COVID-19) pandemic (1)and the recovery and adaptation of health services is widely unknown(2). The purpose of this study is to reflect on the health service experiences of women with a diagnosis of BC in Ireland during the pandemic and to propose patient-centered priorities and recommendations to improve BC services moving forward from COVID-19. The study included semi-structured qualitative interviews (n = 28) with women who participated in a related mixed-methods cohort study. Women with a diagnosis of BC within 5 years in Ireland were initially enrolled and women were selected for interviews through stratified purposive sampling to ensure data was available on diverse cases. Interviews took place in early 2023 to reflect on perspectives from the COVID-19 government lockdown. Thematic analysis was conducted using NVivo software. Thematic analysis highlighted three main themes: unmet needs; patient priorities; and recommendations. Women discussed unmet needs such as routine care fall-out, mental well-being, and financial difficulties. Patient priorities included cohesion among multidisciplinary BC care, proper communication with BC health professionals, and self-empowerment in BC care. Lastly, women recommended improvements for the transition from active treatment, support services, and adaptation of telemedicine. “I do think that any patient going through cancer treatments, it's not just breast cancer, any patient ... there needs to be a little bit more support for the aftercare.” The pandemic has impacted BC services considerably, and this impact has accentuated unmet needs for women with BC in Ireland. Considering these unmet needs from varying backgrounds, patient- centred priorities and recommendations were proposed. To conclude, the patient voice should be prioritized when implementing changes for improvement to health services. Key messages • Health systems must learn from the pandemic to improve services and to avoid detrimental impact of future disasters. • The patient voice should be a key stakeholder when implementating health policies.

Postmastectomy Breast Reconstruction Patterns at an Urban Academic Hospital and the Impact of Surgeon Gender

BackgroundPostmastectomy breast reconstruction is an essential element of multidisciplinary breast cancer care but may be underutilized.MethodsThis retrospective study analyzed mastectomy patients (2018–2021) at an urban hospital. Multivariable logistic regression was performed, and a mixed-effects logistic regression model was constructed to determine patient-level factors (age, race, body mass index, comorbidities, smoking status, insurance, type of surgery) and provider-level factors (breast surgeon gender, participation in multidisciplinary breast clinic) that influence reconstruction.ResultsOverall, 167 patients underwent mastectomy. The reconstruction rate was 35%. In multivariable analysis, increasing age (odds ratio [OR] 0.95; 95% confidence interval [CI] 0.91–0.99) and Medicaid insurance (OR 0.18; 95% CI 0.06–0.53) relative to private insurance were negative predictors, whereas bilateral mastectomy was a positive predictor (OR 7.07; 95% CI 2.95–17.9) of reconstruction. After adjustment for patent age, race, insurance, and type of surgery, female breast surgeons had 3.7 times greater odds of operating on patients who had reconstruction than males (95% CI 1.20–11.42).ConclusionBoth patient- and provider-level factors have an impact on postmastectomy reconstruction. Female breast surgeons had nearly four times the odds of caring for patients who underwent reconstruction, suggesting that a more standardized process for plastic surgery referral is needed.

Multidisciplinary blended learning to build a breast cancer specialist career: survey on the perspective of the first 2 cohorts of the ESO-ULM Certificate of Competence in Breast cancer (CCB).

BackgroundBreast Cancer (BC) specialists need to acquire comprehensive knowledge, covering their own specialty and principles of related disciplines. Blended learning, the integration of online and face-to-face learning, is becoming more and more important in academic education and has added value during pandemics which limit face-to-face learning and residential training.In this context, the ESO-ULM Certificate of Competence in Breast Cancer (CCB) provides postgraduate multidisciplinary education and delivers an academic postgraduate title.The aim of this work is to investigate the degree of satisfaction of 42 participants to the first two editions of the programme and to assess if attending the programme entailed any professional gain.MethodsAn ad-hoc questionnaire was developed exploring 4 areas: participants’ characteristics, administrative aspects, CCB Program syllabus and design, professional impact.ResultsThe program was attractive for specialists of different disciplines from all over the world: > 90% of responders appreciated the curriculum set up and the quality of the teaching.Despite 64% of responders changed their clinical practice, only 33% could implement institutional changes. One third of the participants activated a collaboration with other colleagues and 64% used the CCB as a trigger to take part in other educational activities.Only 12% of the participants had the opportunity, after CCB, to visit other BC Units or to be involved in international research projects.More than half of the attendees profited from attending CCB in terms of promotions (16.7%), change of working institution (9.5%) or development of a more structured educational program at their home institutions (28.6%).ConclusionsResults provide interesting and stimulating considerations on the expectations and needs of training physicians and on what modern educational tools and formats can achieve. This paper can provide useful information to navigate through what the post-graduate training market is currently offering to develop a specific curriculum in modern multidisciplinary BC care but might not be applicable to other fields of multidisciplinary oncology.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12909-022-03414-7.

Overcoming disparities: Multidisciplinary breast cancer care at a public safety net hospital.

Public safety net hospitals (SNH) serve a disparate patient population; however, little is known about long-term oncologic outcomes of patients receiving care at these facilities. This study is the first to examine overall survival (OS) and the initiation of treatment in breast cancer patients treated at a SNH. Patients presenting to a SNH with stage I-IV breast cancer from 2005 to 2017 were identified from the local tumor registry. The hospital has a weekly breast tumor board and a multidisciplinary approach to breast cancer care. Kaplan-Meier survival analysis was performed to identify patient, tumor, and treatment characteristics associated with OS. Factors with a p < 0.1 were included in the Cox proportional hazards model. 2709 breast cancer patients were evaluated from 2005 to 2017. The patient demographics, tumor characteristics, and treatments received were analyzed. Five-year OS was 78.4% (93.9%, 87.4%, 70.9%, and 23.5% for stages I, II, III, and IV, respectively). On multivariable analysis, higher stage, age > 70years, higher grade, and non-Hispanic ethnicity were associated with worse OS. Patients receiving surgery (HR = 0.33, p < 0.0001), chemotherapy (HR = 0.71, p = 0.006), and endocrine therapy (HR = 0.61, p < 0.0001) had better OS compared to those who did not receive these treatments. Despite serving a vulnerable minority population that is largely poor, uninsured, and presenting with more advanced disease, OS at our SNH approaches national averages. This novel finding indicates that in the setting of multidisciplinary cancer care and with appropriate initiation of treatment, SNHs can overcome socioeconomic barriers to achieve equitable outcomes in breast cancer care.

Severe Impact of Covid-19 Pandemic on Breast Cancer Care in Italy: A Senonetwork National Survey

Severe Impact of Covid-19 Pandemic on Breast Cancer Care in Italy: A Senonetwork National Survey

MHealth for breast cancer patient navigation: What patients want—What clinicians need.

e19244 Background: mHealth interventions support patient behavior change, promote adherence to treatment provide patient education, and clinical decision support. Research on mHealth interventions has focused on unidirectional communication from providers to patients. mHealth to support patient navigation through multidisciplinary breast cancer care (MBCC) has not been realized. Our team explored the information needs and perceived benefits and barriers to the design and adoption of mHealth solutions to support patient-centered MBCC. Methods: We conducted a prospective cohort study with patients and family members of patients with breast cancer (Stage 0-III), clinicians and practice staff participated semi-structured interviews/focus group to explore stakeholder perceptions of mHealth across the domains of: information needs, communication, technology preferences, and barriers and facilitators to adoption and implementation. Transcripts were analyzed using concurrent content analysis and recruitment continued until saturation of themes was achieved within each stakeholder group. Results: We conducted 22 interviews and 5 focus groups with 49 participants generating 466 individual responses. Patients, clinicians, and staff found existing communication pathways (e.g., calls to office, patient portal) sufficient in meeting patient’s needs. Family members and caregivers saw the potential of mHealth as beneficial to decision-making and treatment adherence. Patient access to health information on a smartphone between visits was perceived positive to support care organization. Clinicians and staff recognized the need for patient engagement to optimize treatment outcomes. Concerns about workload, privacy and security, and misinterpretation of information shared in mHealth apps were perceived as barriers to adoption. Recommendations included EHR integration, existing “in-box” management workflow, and team engagement in information management processes. Conclusions: mHealth can play a pivotal role in supporting patient-clinician-family dynamics for MBCC. Designers of mHealth should carefully consider the relative value of applications to the clinical workflow, patient and family needs, and identify team-based approaches to supporting adoption and implementation.

Engaging patients on tumor boards: A multi-stakeholder perspective study.

e19243 Background: Patient and family-centered care (PFCC) is grounded in the concepts of dignity and respect, information sharing, and active participation and collaboration in their health care. Efforts to engage patients and family members as part of the healthcare team as part of robust multidisciplinary breast cancer care (MBCC), including in multidisciplinary tumor boards, is an extension of PFCC for breast cancer care. Our team explored multi-stakeholder perspectives of engaging patients as partners on a virtual multidisciplinary tumor board (MTB) using an mHealth application. Methods: We conducted a prospective cohort study employing semi-structured interviews and focus group methodology to explore stakeholder (patients with Stage 0-III breast cancer, family members/caregivers, clinicians, and tumor board staff) perspectives of engaging patients in a virtual MTB. Interviews and focus groups were audiotaped, transcribed, and analyzed using concurrent content analysis to identify common themes. Recruitment continued until saturation of themes was achieved. Results: We conducted 22 interviews and 5 focus groups with 49 participants. Patients and family members reported discomfort with idea of engaging in MTB discussions about their cancer. Disease burden, limited understanding of medical terminology, and not wanting to be a part of the early discussions about their disease (e.g., being overwhelmed, need to trust clinician’s advice) were commonly reported. Clinicians and staff also reported concerns about patient engagement in MTB. Clinicians reported that it may change the candor of the discussions at MTB and obfuscate the problems/issues if they needed to modify their language to accommodate patients’ sensitivities. Clinicians and staff were also concerned about patient’s perception of discordance within the MTB clinician members and how to explain this uncertainty to patients. Staff concerns centered around the use of medical terminology which may create anxiety and result in patient misunderstanding. Conclusions: Clinicians, staff, patients and family members were overwhelmingly concerned about adding patients to the MTB. Engaging patients in the frank and candid early treatment planning discussions may need further evaluation in a clinical environment and among different patient cohorts.

Development of Residents’ Self-Efficacy in Multidisciplinary Management of Breast Cancer Survey

BackgroundTreating patients with breast cancer is multidisciplinary; however, it is unclear whether surgery residency programs provide sufficient training in multidisciplinary care. Self-efficacy is one way of measuring the adequacy of training. Our goal was to develop a method of assessing self-efficacy in multidisciplinary breast cancer care. MethodsBased on a literature review and subject-matter expert input, we developed a 30-item self-efficacy survey to measure six domains of breast cancer care (genetics, surgery, medical oncology, radiation oncology, pathology, and radiology). We constructed and validated the survey using a seven-step survey development framework. The survey was administered to general surgery residents at a single academic surgical residency. ResultsResponse rate was 66% (n = 31). Internal consistency was strong (Cronbach alpha = 0.92). Self-efficacy was moderate (mean = 3.05) and tended to increase with training (postgraduate year [PGY] 1: mean= 2.37 versus PGY 5: mean= 3.54; P < 0.001), providing evidence for construct validity. Self-efficacy was highest in the surgery (3.56) compared with others (genetics 2.67, medical oncology 3, radiation oncology 2.67, pathology 2.67, and radiology 3.33). This trend was similar across all PGY groups, except for interns, whose self-efficacy in surgery was low. ConclusionsWe created a survey to assess self-efficacy in multidisciplinary breast cancer care and provided initial evidence of survey validity. Although self-efficacy in surgery improved with years in training, medical and radiation oncology self-efficacy remained low. As modern breast cancer treatment is highly multidisciplinary, an expanded education program is needed to help trainees incorporate multidisciplinary clinical perspectives.

Overcoming Disparities: Multidisciplinary Breast Cancer Care at a Public Safety-Net Hospital

Kelly, Kristin N. MD, MPH; Ryon, Emily MD; Allen, Ahkeel MD; Franceschi, Dido MD, FACS; Moller, Mecker MD, FACS; Avisar, Eli MD, FACS; Kobetz, Erin N. PhD, MPH; Merchant, Nipun MD, FACS; Kesmodel, Susan B. MD, FACS; Goel, Neha MD Author Information

Does a Comprehensive Multidisciplinary Care Program Impact Utilization of Genetics in Breast Cancer Management? [11L

INTRODUCTION: To evaluate the utilization of genetic testing after the implementation of a comprehensive multidisciplinary breast cancer care (cMDC) program: ALL breast cancer cases undergo a mandated, standardized/structured review of treatment options and ongoing care (including clinical trial opportunities). METHODS: A retrospective chart review of 542 patients newly diagnosed with invasive breast cancer one year prior to and after the incorporation of a cMDC program was performed for primary outcome: rate of overall appropriate genetic referrals as defined by age, family history, triple negative status, and personal history. Secondary outcomes: compliance and equity in genetic referrals across demographics (race, insurance type and hospital site). SPSS was used for multivariate analysis, (P&lt;.05). RESULTS: There were 123 pre-cMDC and 419 cMDC patients. A positive pathologic genetic mutation was seen in 2.2% of patients. Comparison of pre-cMDC and cMDC patients yielded a significant increase in appropriate genetic referrals (34.1%–41.8%), a decrease in withholding genetic referral when indicated (59.3%–21.7%) and an increase in inappropriate referrals (1.9%–11.7%) respectively (P=.001). Amongst both study arms Caucasians were more compliant genetic appointment compared to their African American counterparts (pre-cMDC P=.011, cMDC P=.016). African Americans in the cMDC group demonstrated an 11% increase in attendance compared to a 1% decrease noted among Caucasians in the cMDC group. Genetic referrals were equally offered appropriately before and after the implementation of the MDC across race, insurance type and location. CONCLUSION: Utilizing a cMDC approach to breast cancer care may help increase appropriate utilization of genetics, reach more African-Americans and identify those with pathologic mutations.

Reoperation after breast-conserving surgery for cancer in Australia: statewide cohort study of linked hospital data

ObjectivesTo investigate between-hospital variation in the probability of reoperation within 90 days of initial breast-conserving surgery (BCS), and the contribution of health system-level and other factors.DesignPopulation-based, retrospective cohort study.SettingNew South...

Development of multi-disciplinary breast cancer care in Southern Malawi.

The Edinburgh Malawi Breast Cancer Project, a collaborative partnership project between the Queen Elizabeth Central Hospital (QECH) Oncology Unit, Blantyre, Malawi and the Edinburgh Cancer Centre, UK, was established in 2015. The principal objective of the project is to help to develop high quality multi-disciplinary breast cancer care in Malawi. A needs assessment identified three priority areas for further improvement of breast cancer services: multi-disciplinary working, development of oestrogen receptor (ER) testing and management of clinical data. A 3-year project plan was implemented which has been conducted through a series of reciprocal training visits. Key achievements to date have been: (1) Development of a new specialist breast care nursing role; (2) Development of multi-disciplinary meetings; (3) Completion of a programme of oncology nursing education; (4) Development of a clinical database that enables prospective collection of data of all new patients with breast cancer; (5) Training of local staff in molecular and conventional approaches to ER testing. The Edinburgh Malawi Breast Cancer Project is supporting nursing education, data use and cross-specialty collaboration that we are confident will improve cancer care in Malawi. Future work will include the development of a breast cancer diagnostic clinic and a breast cancer registry.

Pilot Survey of Breast Cancer Management in Sub-Saharan Africa.

PurposeTo understand the current state of breast cancer management in sub-Saharan Africa.MethodsWe conducted an anonymous online survey of breast cancer management among African Organization for Research and Treatment in Cancer (AORTIC) members by using a 42-question structured questionnaire in both English and French in 2013.ResultsTwenty members from 19 facilities in 14 countries responded to the survey. Twelve members (60%) belonged to a multidisciplinary breast cancer team. Radiotherapy equipment was available in seven facilities (36%), but equipment had down time at least once a week in four facilities. Available chemotherapy drugs included methotrexate, cyclophosphamide, fluorouracil, anthracyclines, and vincristine, whereas trastuzumab, taxanes, vinorelbine, and gemcitabine were available in few facilities. Core-needle biopsy was available in 16 facilities (84%); mammogram, in 17 facilities (89%); computed tomography scan, in 15 facilities (79%); magnetic resonance imaging, in 11 facilities (58%); and bone scans, in nine facilities (47%). It took an average of 1 to 3 weeks to report histopathology. Immunohistochemistry was available locally in eight facilities (42%), outside hospitals but within the country in seven facilities (37%), and outside the country in four facilities (21%). Thirteen facilities (68%) performed axillary node dissections as part of a breast protocol. Neoadjuvant chemotherapy was the most common therapy for locally advanced breast cancer in 13 facilities (68%). In three facilities (16%), receptor status did not influence the prescription of hormone treatment.ConclusionThis pilot survey suggests that AORTIC members in sub-Saharan Africa continue to make gains in the provision of access to multidisciplinary breast cancer care, but the lack of adequate pathology and radiotherapy services is a barrier. Focused attention on in-country and regional training needs and improvement of health systems deliverables is urgently needed.

Abstract 1647: Radiation response genome-wide analysis using paired pre and post-radiation FFPE human breast tumor samples

Abstract Background: Breast cancer is the most common female malignancy in the US, and radiotherapy is a routine part of multi-disciplinary breast cancer care. Radiation treatment (RT) tailored to target radiation response pathways could maximize treatment benefit in radiation resistant tumors, while minimizing unnecessary toxicity and cost in more radiation responsive breast tumor subtypes. Here we report on genome-wide analysis, gene expression profiles and biological pathways associated with RT response in breast cancer patients. Methods: Between 2010-2013, a total of 32 breast cancer patients were enrolled at Duke University Medical Center on an IRB approved Phase I clinical trial testing preoperative radiotherapy. Paired pre and post-RT FFPE biopsy samples were available for N = 26. Genome wide-analysis was performed using two distinct techniques: i) Microarray analysis using the Affymetrix GeneChip ® Human Transcriptome Array 2.0 (HTA 2.0); ii) RNA-Seq using TruSeq ®RNA Access Library kit (Illumina). All libraries were sequenced on the Illumina HiSeq 2000 generating 50 bp single reads at a sequencing depth of 40 million reads. The RNA-Seq data was processed using the TrimGalore toolkit. For the paired pre and post-RT differential gene expression analysis we used the linear model. Genes that had an FDR ≤ 5% in the RNA-Seq experiment were compared with all microarray probesets that had an FDR ≤ 5%. If at least one probeset that belonged to a gene in the RNA-Seq list was significant and showed the same direction of change between pre and post-RT samples, they were identified as consistent. Gene Set Enrichment Analysis (GSEA) and Database for Annotation, Visualization and Integrated Discovery (DAVID) were used to identify significant pathways and gene ontologies that were differentially regulated between the conditions. Results: 2648 genes showed the same significant results in response to RT in microarray and RNA-Seq including: i) a total of 1401 genes that had significantly higher expression levels, and ii) a total of 1247 genes that had significantly lower expression levels following RT. Principal Components Analysis (PCA) demonstrated distinct separation of pre and post-RT gene expression signatures. Differentially expressed genes were involved in major biological pathways such as cell cycle checkpoint, DNA replication and DNA repair pathways. A subset of these genes also demonstrated differential expression in radiation responsive vs. non-responsive breast cancer cell lines. Conclusion: New laboratory techniques have become available which provide the opportunity to use FFPE samples for microarray and RNA-seq analysis. Using these new techniques and our rare pre and post-RT FFPE breast tumor samples, we have been able to demonstrate distinct differences in gene expression profiles and modulation of biological pathways in response to RT in human breast tumors. Citation Format: Sharareh Siamakpour-Reihani, Wei Chen, David Corcoran, Chen-Ting Lee, Ying Zhou, Mark W. Dewhirst, Jen-Tsan A. Chi, Janet K. Horton. Radiation response genome-wide analysis using paired pre and post-radiation FFPE human breast tumor samples. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1647.

The Edinburgh Malawi Cancer Partnership: helping to establish multidisciplinary cancer care in Blantyre, Malawi.

In response to the growing incidence of cancer in Malawi, a new oncology unit was established at the Queen Elizabeth Central Hospital, Blantyre. The unit opened in 2010, the first in the country, and is led by a single consultant oncologist. In 2012, a healthcare partnership was formed between the oncology and palliative care unit at Queen Elizabeth Central Hospital and the Edinburgh Cancer Centre, UK. The principal objective of the partnership is to help develop high quality multidisciplinary cancer care in Malawi. Methods A needs assessment identified three priority areas for further improvement of cancer services: nurse-led treatment delivery; management of clinical data; and multidisciplinary working. The partnership received grant funding from the Scottish Government Malawi Development Programme in 2013 and a three year project plan was implemented. This has been conducted through a series of reciprocal training visits. Results Key achievements have been completion of a programme of oncology nursing education attended by 32 oncology nurses and other healthcare professionals, which has resulted in increased experience in cancer practice and standardisation of chemotherapy delivery procedures; development of a clinical database that enables prospective collection of data of all new patients with cancer and which links to the Malawi Cancer Registry; development of weekly multidisciplinary meetings involving oncology, gynaecology and surgery that has enabled a cross-specialty approach to patient care. Conclusion The Edinburgh Malawi Cancer Partnership is supporting nursing education, data use and cross-specialty collaboration that we are confident will improve cancer care in Malawi. Future work will focus on the further development of multidisciplinary breast cancer care and the development of a radiotherapy service for patients in Malawi.

Incorporating Patient Satisfaction Metrics in Assessing Multidisciplinary Breast Cancer Care Quality.

The Medical University of South Carolina implemented a patient-centered multidisciplinary breast clinic program (MDBC) in August 2012. In this study, patient satisfaction with the MDBC care delivery model and communication with healthcare providers was examined to inform the refinement of the MDBC program. During the first 10 months of the MDBC, patients were asked to complete a 14-question postconsultation telephone survey. A statistical analysis was performed to explore potential associations between age, race, and stage with overall patient satisfaction scores. Overall, patients (N = 52, 56% white, 42% African American, 2% Hispanic; mean age 61 years) rated the quality of care highly (mean 4.7, range [1 = poor to 5 = excellent]) and felt comfortable with their plan of care (mean 1.63, range [1 = extremely comfortable to 5 = not at all comfortable]). No statistically significant differences in overall satisfaction were found by age, race, or stage; however, patient responses were commonly not optimal (ie, either "no" or "yes, but not as much as I would like") when asked if the care team addressed the impact of their diagnosis on personal relationships (40.4%) or emotional health (28.9%). Patients were highly satisfied with the care they received in the MDBC program. Findings suggest that this model is well suited to a diverse patient population and have highlighted quality improvement targets such as increased emphasis on providers' communication about psychosocial issues.

Abstract P1-16-02: Multidisciplinary breast cancer care is associated with a higher rate of breast conservation in comparison with non-multidisciplinary care

Abstract Background Mastectomy rates, both therapeutic and prophylactic, are on the rise in the United States. After recent implementation of a multidisciplinary breast clinic for newly diagnosed women at our institution, we sought to examine the impact of multidisciplinary care on surgical decision making. Materials/Methods Women with newly diagnosed breast cancer at our institution are referred to a multidisciplinary breast clinic where they are seen by a team of breast specialists (MDC) or to an individual practitioner (non-MDC) for initial consultation. We retrospectively analyzed rates of breast conserving surgery (BCS) and mastectomy among women with newly diagnosed breast cancer seen in either setting. For mastectomy cases, we designated the mastectomy as clinically indicated vs not clinically indicated based on National Comprehensive Cancer Network (NCCN) guidelines for breast conservation. T-test and chi-square were used to examine the comparability between MDC and non-MDC cohorts. Logistic regression was used to evaluate the overall prevalence of BCS among MDC and non-MDC cohorts. Stratification analysis was further conducted to examine BCS rates among women in each cohort receiving neoadjuvant chemotherapy vs up front surgery. Results A total of 341 consecutive patients were analyzed, including 202 MDC and 139 non-MDC patients seen in initial consultation between June 2012 and April 2014. The MDC and non-MDC cohorts were statistically equivalent in terms of age, tumor and nodal stage, histology, biomarker status, receipt of neoadjuvant chemotherapy, and proportion with genetic mutations. In the MDC cohort, 66% underwent BCS vs 42% in the non-MDC cohort (p&amp;lt;0.0001). Of those receiving neoadjuvant chemotherapy, 37% in the MDC cohort underwent BCS vs 12% in the non-MDC cohort (p=0.08). Of those proceeding to surgery without neoadjuvant therapy, 70% underwent BCS in the MDC cohort vs 46% in the non-MDC cohort (p&amp;lt;.0001). Among mastectomies performed in the MDC vs non-MDC cohorts, 77% and 41% respectively were clinically indicated (P&amp;lt;.0001). Rates of unnecessary contralateral prophylactic mastectomy were comparable in both groups, 39% (p=0.99). Conclusions Breast cancer patients seen in an MDC setting at the time of initial diagnosis are significantly more likely than women seen in a non-MDC setting to undergo breast conservation. We hypothesize that the MDC model of breast cancer care, via facilitation of more informed medical decision making, may be a viable strategy to curtail rising mastectomy rates in the United States. Citation Format: Caitlin L Gomez, Pin-Chieh Wang, Nicole A Dawson, Robyn L Dvorak, Nova Foster, Anne Hoyt, Sara A Hurvitz, Amy Kusske, Charles Y Tseng, Susan A McCloskey. Multidisciplinary breast cancer care is associated with a higher rate of breast conservation in comparison with non-multidisciplinary care [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-16-02.