Clinical Outcomes in Two Different Cohorts of Patients with Inflammatory Breast Cancer (IBC) Treated at the MD Anderson Cancer Center: The Experience of the Morgan Welch IBC Research Program and Clinic.

118 Background: Guidelines for treating inflammatory breast cancer (IBC) using trimodality (chemotherapy, surgery and radiation) therapy (TT) remain largely unchanged since 2000. However, many such patients did not receive TT. It is unknown how patient-level (PL) and facility-level (FL) factors contribute to TT utilization. Methods: Using the National Cancer Data Base (NCDB), patients who underwent surgical treatment of locoregional IBC from 2003-2011 were identified. We correlated patient, tumor, and treatment data with TT. An observed to expected (O/E) ratio of number of patients treated with TT was calculated for each hospital by adjusting for PL factors. Hierarchical mixed effects models were used to assess the proportion of variation in the use of TT attributable to PL and FL factors, respectively. Results: Among 5,537 patients who met the study criteria, the use of TT fluctuated annually (67.3%-75.7%) and was less likely for patients who were over 70, had a lower income or had an N0 tumor (all p < 0.05). By insurance type, TT use was lowest among Medicare patients. Of the 542 hospitals examined, 55 (10.1%) and 24 (4.4%) were identified as significantly low and high outliers for the use of TT (p < 0.05), respectively. While comprehensive cancer centers represented the majority of high outliers, the TT use by facility type overall was not significantly different demonstrating variability within comprehensive cancer center practice. The percentage of the total variance in the use of TT attributable to facility (11%) was almost triple the variance attributable to the measured PL factors (3.4%). Conclusions: The use of standard of care TT varied widely across facilities with some high volume centers clearly underutilizing TT. To improve clinical outcomes for this rare and aggressive malignancy, it is critical to identify facility level factors impacting the use of TT to ensure the guideline adherence of IBC treatment.

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Integrative Medicine Program- MD Anderson Cancer Center

Revista Brasileira de Medicina de Família e Comunidade ◽

10.5712/rbmfc7(1)519 ◽

2012 ◽

Vol 7 ◽

pp. 19

Author(s):

Richard T Lee

Keyword(s):

Clinical Outcomes ◽

Integrative Medicine ◽

Clinical Care ◽

Cancer Center ◽

Future Research ◽

Clinical Services ◽

Care Plans ◽

Md Anderson ◽

Integrative Medicine Program ◽

Group Programs

The Integrative Medicine Program at MD Anderson Cancer Center was first established in 1998. Our mission is to empower patients with cancer and their families to become active partners in their own physical, psycho-spiritual, and social health through personalized education and evidenced-based clinical care to optimize health, quality of life, and clinical outcomes across the cancer continuum. The program consists of three main components: clinical care, research, and education. The Integrative Medicine Center provides clinical services to patients through individual and group programs. The clinical philosophy of the center is to work collaboratively with the oncology teams to build comprehensive and integrative care plans that are personalized, evidence-based, and safe with the goal of improving clinical outcomes. The individual services comprise of integrative oncology consultation, acupuncture, meditation, music therapy, nutrition, and oncology massage. The center also provides a variety of group programs including meditation, yoga, tai chi, cooking classes and others. Over the past 13 years, over 70,000 patients and families have participated in services and programs offered by the center. The research portfolio focuses on three main areas: mind-body interventions, acupuncture, and meditation. This lecture will focus on providing an overview of the Integrative Medicine Program at MD Anderson with a focus on the clinical services provided. Participants will learn about the integrative clinical model and how this is applied to the care of cancer patients at MD Anderson Cancer Center. Current and future research topics will be discussed as well as patient cases.

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