Effect of a new model for multidisciplinary breast cancer care on clinical metrics leading to efficiency and timeliness of access.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 107-107
Author(s):  
Rashmi Krishna Murthy ◽  
Susan E Ferguson ◽  
Welela Tereffe ◽  
Isabelle Bedrosian ◽  
Stacy L. Moulder
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Cancer Center ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Breast Cancer Care ◽  
University Of Texas ◽  
Breast Center ◽  
Receive Treatment ◽  
Md Anderson

107 Background: The multidisciplinary approach to breast cancer care provides a coordinated mechanism for evaluating and treating new patients. Improving the structure of clinic models may further enhance the delivery of cancer care. Methods: In May 2013, multi-team (MT) clinics were introduced in the breast center at the University of Texas MD Anderson Cancer Center. Local patients with newly diagnosed breast cancer were scheduled to be seen in a MT clinic with testing coordinated for the same day. Patient cases were first reviewed and examined concurrently by physicians from each discipline (surgical, medical, radiation), followed by sequential visits with each clinician for a more detailed discussion. The goal of this program was to determine whether a highly integrated multidisciplinary clinic model would improve the efficient delivery of cancer treatment. Results: From 5/2013 – 5/2014, 211 newly diagnosed and untreated breast cancer patients were seen in the MT clinic. Clinical metrics were reviewed retrospectively and compared to newly diagnosed and untreated patients who entered the clinic using the standard model (non-MT patients) (n=1944). Please see Table for details of the data. Conclusions: Multi-team clinics improved clinical metrics leading to efficiency and timeliness of access. The model enriched for a population of patients who were more likely to receive treatment within the breast center, utilize institutional resources, and enroll into clinical trials. [Table: see text]

Breast cancer: Global quality care

2019 ◽  
Keyword(s):  
Breast Cancer ◽  
Best Practices ◽  
Cancer Care ◽  
Care Pathway ◽  
Health Care Systems ◽  
Quality Care ◽  
Breast Cancer Patients ◽  
Breast Cancer Care ◽  
Global Quality ◽  
Care Systems

Caregivers delivering care to breast cancer patients wish to provide the highest quality breast care possible. Due to the complexity of the care pathway, this care should be delivered by a multidisciplinary team working in a breast cancer unit/centre. This book was written by experts from different disciplines and presents ideas for developing a breast unit wherever you live. The authors provide thorough descriptions of high-quality breast cancer care, define targets, methods to assess one’s care, and ideas on how to improve care within one’s resources. A global view of the quality of breast cancer care shows specific best practices applicable to many centres operating in various health care systems with different financial and political situations. Foundation hallmarks of innovation, communication, patient-centred care, multidisciplinary, and budget considerations guide specific recommendations for each component of care. This book discusses global and local considerations so that optimally ‘integrated’ breast cancer care can be organized. Each component of care (e.g. imaging, surgery, etc.) is discussed from both theoretical and practical aspects. The recommendation for each component of care is facilitated by experienced experts laying out rational and practical approaches to each step. This book provides guidance how to integrate the different disciplines into breast cancer care. Beyond treatment, it provides practical considerations regarding accreditation and certification, and it comments on the influence of budget and of treatment. Finally, it demonstrates how best practices may be altered by the emerging involvement of patients, technologies, and transitions of future societal values.

What Are the Ethical Implications of Understanding and Treating Breast Cancer?

2018 ◽  
Author(s):  
Mary Ann G. Cutter
Keyword(s):  
Breast Cancer ◽  
Risk Assessment ◽  
Informed Consent ◽  
Cancer Care ◽  
The United States ◽  
Breast Cancer Patients ◽  
Breast Cancer Care ◽  
Ethical Implications ◽  
Personalized Approach ◽  
Limit Access

Philosophically speaking, the question “What are the ethical implications of understanding breast cancer?” raises a host of issues, including informed consent, risk assessment, and access to breast cancer care. What we find is that, initially, there are adequate guidelines for informed consent, adequate efforts to develop risk assessment measures, and a decent level of access to breast cancer care in the United States. But things can be improved from an ethical standpoint. Upon reflection, the informed consent process would benefit from a more explicit discussion of uncertainty in breast cancer medicine and the ways breast cancer patients make decisions about their care. Risk assessments would benefit from a more personalized approach. Access to breast cancer care could be improved by continued studies of the diverse forces that limit access to proper breast cancer care.

Understanding Disparities in Breast Cancer Care in Memphis, Tennessee

2018 ◽  
Vol 84 (5) ◽  
pp. 620-627 ◽  
Author(s):  
Elena P. Lamb ◽  
F. Elizabeth Pritchard ◽  
Simonne S. Nouer ◽  
Elizabeth A. Tolley ◽  
Brandon S. Boyd ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Confidence Interval ◽  
Cancer Patients ◽  
Cancer Care ◽  
White Women ◽  
Clinical Stage ◽  
Breast Cancer Patients ◽  
Breast Cancer Care ◽  
Black Patients ◽  
White Patients

Although significant progress has been made in improving breast cancer survival, disparities among racial, ethnic, and underserved groups still exist. The goal of this investigation is to quantify racial disparities in the context of breast cancer care, examining the outcomes of recurrence and mortality in the city of Memphis. Patients with a biopsy-proven diagnosis of breast cancer from January 1, 2002, through December 31, 2012, were obtained from the tumor registry. Black patients were more likely to have advanced (II, III, or IV) clinical stage of breast cancer at diagnosis versus white patients. Black breast cancer patients had a two times higher odds of recurrence (95% confidence interval: 1.4, 3.0) after adjusting for race and clinical stage. Black breast cancer patients were 1.5 times more likely to die (95% confidence interval: 1.2, 1.8), after adjusting for race; age at diagnosis; clinical stage; ER, PR, HER2 status; and recurrence. Black women with stages 0, I, II, and III breast cancer all had a statistically significant longer median time from diagnosis to surgery than white women. Black patients were more likely to have advanced clinical stages of breast cancer at diagnosis versus white patients on a citywide level in Memphis. Black breast cancer patients have higher odds of recurrence and mortality when compared with white breast cancer patients, after adjusting for appropriate demographic and clinical attributes. More work is needed to develop, evaluate, and disseminate interventions to decrease inequities in timeliness of care for breast cancer patients.

Quality of care for breast cancer patients in Japan: An analysis of the Japanese Breast Cancer Registry

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6547-6547
Author(s):  
H. Mukai ◽  
T. Higashi ◽  
T. Iwase ◽  
T. Sobue
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cancer Registry ◽  
Cancer Care ◽  
Breast Cancer Patients ◽  
Breast Cancer Care ◽  
Recommended Care ◽  
Adherence Score ◽  
Breast Cancer Registry

6547 Background: In Japan, growing concern that patients do not receive optimum care led to the enactment of the Cancer Control Act in 2006, which mandates the government to undertake initiatives in ensuring the quality of cancer care. Here, we evaluated the current status of breast cancer care in Japan using process-of-care quality indicators (QIs) for breast cancer care. Methods: Combining clinical evidence and expert opinion, we developed 45 QIs covering the continuum of breast cancer care from initial evaluation to follow-up. Each QI describes standards of a particular aspect of care, and its score is calculated as the percentage of applicable patients who received the recommended care (adherence score). Of the 45 QIs, 7 could be scored using data in the Japanese Breast Cancer Registry, which covers about 40% of all Japanese breast cancer patients and has been continuously maintained since 1975. Results: The study population included 15,227 patients registered by 224 facilities in 2005. On average, patients received 72.1% of recommended care. However, substantial variation in adherence was seen across QIs (21–98%). Adherence score was less than 85% in five of seven QIs. Variation across facilities was observed in six QIs. Conclusions: The quality of breast cancer care in Japan has room for improvement in many aspects of care. Although the amount of data in the cancer registry suitable for quality assessment is limited, it is useful in detecting quality problems. [Table: see text] No significant financial relationships to disclose.

Assessing the quality of breast cancer care in cancer center hospitals in Japan.

2011 ◽  
Vol 29 (15_suppl) ◽  
pp. e16566-e16566 ◽  
Author(s):  
T. Higashi ◽  
F. Nakamura ◽  
H. Mukai ◽  
T. Sobue ◽  
E. Mekata ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Cancer Center ◽  
Breast Cancer Care

Standardizing quality breast cancer care throughout all New York university facilities.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 160-160
Author(s):  
Anna C. Pavlick ◽  
Freya Ruth Schnabel ◽  
Amy Tiersten ◽  
Matthew Volm ◽  
Jennifer J. Wu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
New York ◽  
Cost Effectiveness ◽  
Cancer Care ◽  
Treatment Algorithm ◽  
Care Program ◽  
Cancer Center ◽  
Breast Cancer Care ◽  
New York University ◽  
Provider Satisfaction

160 Background: NYU physicians provide breast cancer care (BCC) at several locations throughout New York. The NYU Clinical Cancer Center (NYUCCC) is a private, university-based facility while Bellevue and Woodhull Hospitals are city hospitals. The diversity of BCC provided to patients (pts) in city hospitals can vary greatly from that of private centers and intra-center physician variability also diversifies care. This variability can impact on pt satisfaction and outcomes. Breast cancer (Br Ca) pts make up the greatest number of pts seen and treated at all NYU affiliated sites, therefore, a "Br Ca Quality of Care Program" will be incorporated into the electronic medical record (EMR) at all facilities. A treatment algorithm based on the pt’s stage and a simple "drop-down menus" will simplify use. It will encompass diagnostic imaging, pathology, biopsy procedures, surgery, radiation, chemo, and hormonal therapy as well as survivorship guidelines for maintaining wellness. Methods: Leaders of each Br Ca program have identified potential barriers to care and rectifiable issues. Algorithms and “drop down menus” in the EMR will be presented to the NYUCCC Br Ca physicians for feedback. This tool will then be refined and launched at NYUCCC. After evaluating this program at NYUCCC, the data will be presented to the all NYUCCC faculty. Achieving the city hospitals to adopt this EMR program will be the ultimate success and standardized quality care will be the result. Results: An assessment of the endpoints of physician adherence to guidelines, cost effectiveness and pt/provider satisfaction will be conducted 6 months later. Random audits of breast cancer pt charts will evaluate provider compliance. A cost analysis of this care will be done and compared to a random sampling of previously treated pt charts. Review and analysis of this data would be presented to the NYUCCC faculty, then programs launched at both city-hospitals. Conclusions: If the endpoints of quality standardized care, cost effectiveness and pt/provider satisfaction are met, incorporation of similar programs into other high volume oncologic disease entities seen at all NYU facilities would be developed.

Treatment-related leukemia in breast cancer patients treated with fluorouracil-doxorubicin-cyclophosphamide combination adjuvant chemotherapy: the University of Texas M.D. Anderson Cancer Center experience.

1996 ◽  
Vol 14 (10) ◽  
pp. 2722-2730 ◽  
Author(s):  
E Diamandidou ◽  
A U Buzdar ◽  
T L Smith ◽  
D Frye ◽  
M Witjaksono ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Cancer Center ◽  
Routine Practice ◽  
Breast Cancer Patients ◽  
University Of Texas ◽  
Increased Risk ◽  
Fac Chemotherapy ◽  
The University

PURPOSE Adjuvant chemotherapy for breast cancer has been the routine practice in the past decade. A number of studies have observed an increased incidence of treatment-related leukemias following chemotherapy with alkylating agents and/or topoisomerase II inhibitors. We evaluated the incidence of treatment-related leukemias in breast cancer patients treated in four adjuvant and two neoadjuvant chemotherapy trials at The University of Texas M.D. Anderson Cancer Center. PATIENTS AND METHODS Between 1974 and 1989, 1,474 patients with stage II or III breast cancer were treated in six prospective trials of adjuvant (n = 4) or neoadjuvant (n = 2) chemotherapy with fluorouracil, doxorubicin, and cyclophosphamide (CTX) (FAC) with or without other drugs. The median observation time was 97 months. In 1,107 patients, FAC chemotherapy was given postoperatively; 367 patients received induction chemotherapy, as well as postoperative chemotherapy. Eight hundred ten patients had surgery followed by radiotherapy and chemotherapy; 664 patients had surgery and chemotherapy only. Patients in two adjuvant and one neoadjuvant study received higher cumulative doses of CTX compared with those in the other studies. RESULTS Fourteen cases of leukemia were observed. Twelve of these patients had received radiotherapy and chemotherapy, and two had received chemotherapy only. Six of the reported patients with leukemia were treated with a cumulative CTX dose of greater than 6 g/ m2. Five of these patients had received both radiotherapy and chemotherapy. The median latency period in the 14 patients was 66 months (range, 22 to 113). Six of 10 patients with adequate cytogenetic analyses had abnormalities that involved chromosomes 5 and/or 7. The rest of the patients had nonspecific cytogenetic abnormalities or lacked cytogenetic information. The 10-year estimated leukemia rate was 1.5% (95% confidence interval [CI], 0.7% to 2.9%) for all patients treated, 2.5% (95% CI, 1.0% to 5.1%) for the radiotherapy-plus-chemotherapy group, and 0.5% (95% CI, 0.1% to 2.4%) for the chemotherapy-only group; this difference was statistically significant (P = .01). The 10-year estimated leukemia risk for the higher-dose (> 6 g/m2) CTX group was 2% (95% CI, 0.5% to 5.0%) compared with 1.3% (95% CI, 0.4% to 3.0%) for the lower-dose group, a difference that was not statistically significant (P = .53). CONCLUSION These data illustrate that patients treated with adjuvant FAC chemotherapy plus radiotherapy have a slightly increased risk of leukemia. This information needs to be considered in the treatment plans for patients with breast cancer. However, for most patients, the benefits of adjuvant therapy exceed the risk of treatment-related leukemia.

Association between vitamin D deficiency and breast cancer histology: A retrospective database review.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1039-1039
Author(s):  
Ranjana S. Bhargava ◽  
Yue Zhu ◽  
Chana Weinstock ◽  
Nader Hanna ◽  
Katherine Hanna Tkaczuk ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Vitamin D ◽  
African American ◽  
Tumor Size ◽  
Cancer Center ◽  
Inverse Association ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Her 2 ◽  
Retrospective Database

1039 Background: Vitamin D (Vit D) deficiency has been shown to be associated with a higher risk of developing breast cancer. Inverse association has also been shown between vit D level and tumor size. However, the association between vit D deficiency and breast cancer histology remains unclear. Preclinical data has suggested that vit D plays an essential role in the terminal differentiation of breast cells. Thus, we hypothesize that vit D deficiency would be associated with estrogen receptor-negative tumors, particularly triple-negative breast cancers (TNBC) which are associated with aggressive clinical course. Methods: We conducted a retrospective database review to obtain information including age, race, tumor histology, size, stage, and vit D levels in newly diagnosed breast cancer patients at University of Maryland Greenebaum Cancer Center. Results: 150 patients presented between July 2008 and August 2011 were included in this analysis. Average age at diagnosis was 57 (range 30-87), and 56% of patients were African American. Overall, 80% of the patients were vit D deficient at diagnosis, with levels < 30 ng/ml. African-American patients were more likely to be severely vit D deficient with levels < 10 ng/ml compared to Caucasians (33% vs. 7.5%, p= 0.0002). Patients with TNBC were more likely to be vit D deficient at diagnosis compared to hormone receptor-positive patients (93% vs. 76%, p =0.015). These patients also had the lowest mean (18) and median (16) of vit D levels compared to all other patients. This difference is also statistically significant in multivariate analysis when adjusted for age, race, and stage (OR 3.96; p=0.04). Regardless of the ER/PR status, Her 2 negative patients were more vit D deficient compared to Her 2 positive patients (86% vs. 61%, p=0.001). Unlike previous studies, no correlation was seen between tumor size and vit D levels. Furthermore, there is also no association between stage, nodal involvement, or Ki67 and vit D level. Conclusions: Vit D deficiency is common among patients with newly-diagnosed breast cancer, particularly African American patients. Patients with TNBC have a significantly higher likelihood of being vit D deficient than patients with other histological subtypes.

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