Effects of a Multidisciplinary Breast Cancer Clinic in an Appalachian-Based Medical Center

September 2011 Vol 2, No 5

Categories:

Breast Cancer
Jennifer A. Ingham, CNP
Stacey L. Daughtery
Rickey C. Myhand, MD
Wilbur E. Sever, DO
Darla K. Cremeans, RN

Background: Adena Health System is a not-for-profit 250-bed institution that provides healthcare for a 13-county region in southeast Appalachian Ohio. Access to healthcare in rural settings is an ongoing challenge. Several barriers to healthcare access affect this region. Socioeconomic burden and lack of higher education are 2 of the most dominant barriers. In December 2009, we held our first Multidisciplinary Breast Cancer Clinic (MDBCC).

Objectives: The goal of the MDBCC is to facilitate prompt diagnosis and effective treatment. When a patient has a breast biopsy they are asked if they would like a phone call with the pathology results. To date, every patient has chosen to be called with results. The breast care navigator tracks all the breast biopsy pathology results and, when there is a positive pathology report, it is given to a medical oncologist who calls the patient with the requested phone call. The breast care navigator then calls the patient and offers an appointment in the MDBCC, provides the patient with her phone number, and mails the patient educational material on the diagnosis, along with the pathology report. The MDBCC is coordinated by the breast care navigator who meets with the patient the morning of the clinic. The MDBCC is staffed by a team of physicians consisting of surgeons, medical oncologists, and radiation oncologists. Each physician meets with the patient individually, completes an assessment, and educates the patient on his or her specialty. All patients seen that day are discussed by the team at the noon breast tumor board, with input from pathology and radiology to tailor a treatment plan for each patient. After the conference, the recommendations are discussed with the patient before treatment is initiated.

Materials and Methods: In a retrospective review, we evaluated the effect of the MDBCC on days to diagnosis and days from diagnosis to treatment. Since December 2009, there have been more than 90 breast cancer patients evaluated in the MDBCC. We randomly selected 60 breast cancer patients treated prior to MDBCC, between 2008 and 2009, and 66 patients evaluated at the MDBCC between December 2009 and 2011 from the tumor registry database.

Results: The average number of days to diagnosis pre-MDBCC was 15.5 days compared with 4 days post-MDBCC. In 2008/2009, the average days to treatment (pathology result to a port placement, surgery, or chemotherapy) was 18 days compared with 12 days post-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.

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