Patterns of multidisciplinary care in the management of non-metastatic invasive breast cancer in the United States Medicare patient
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Multidisciplinary care (MDC) in managing breast cancer is resource-intensive and growing in prevalence anecdotally, although care patterns are poorly characterized. We sought to determine MDC patterns and effects on care in the United States Medicare patient.
Patients diagnosed with non-metastatic invasive breast cancer from 1992–2009 were reviewed using the Survival, Epidemiology, and End Results (SEER)-Medicare linked dataset. MDC was defined as a post-diagnosis, preoperative visit with a surgical, medical, and radiation oncologist. Same-day MDC (MDCSD) was the MDC subset having all three visits on one date.
Among 88,865 patients, MDC was utilized in 2.9 %, with 14.1 % of these having MDCSD. MDC use did not vary by stage, but MDC patients were more likely to be younger, black, receive lumpectomy, have fewer nodes examined, and receive radiotherapy. MDCSD patients were more likely than non-MDC patients to be black, receive mastectomy, and receive radiotherapy. MDC and MDCSD use increased over time and varied by geographic region, with rural patients less likely to receive MDC (OR 0.54 [95 % CI 0.45–0.65]) and MDCSD (OR 0.32 [95 % CI 0.19–0.54]). Radiotherapy after breast conserving surgery, used in 86.5 % of non-MDC patients, was administered to 90.2 % of MDC (p = 0.001) and 92.6 % of MDCSD (p = 0.019) patients. Post-mastectomy radiotherapy was administered in 52.0 % of non-MDC patients, 63.8 % of MDC (p = 0.050), and 89.1 % of MDCSD (p = 0.298) after propensity score adjustment.
While increasing, few Medicare patients undergo MDC and MDCSD is rare. MDC may improve quality and MDCSD should be considered for patient convenience. While not yet widespread, efforts should integrate MDC and MDCSD across the U.S.
KeywordsMultidisciplinary care Medical oncology Surgical oncology Radiation oncology Breast cancer
This work was supported by the United States Public Health Services grant P30 CA006927 for analysis of the data via support of our biostatistics facility, and by generous private donor support from the Marlyn Fein Chapter of the Fox Chase Cancer Center Board of Associates, for analysis and interpretation of the data. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. The collection of the California cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N02-PC-15105 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement #U55/CCR921930-02 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred. The authors would like to thank Yanqun Dong, M.D., Ph.D. for feedback during manuscript preparation.
Planning: T Churilla, B Egleston, R Bleicher. Conduct: T Churilla, B Egleston, C Murphy, E Sigurdson, S Hayes, L Goldstein, R Bleicher. Reporting: T Churilla, B Egleston, C Murphy, E Sigurdson, S Hayes, L Goldstein, R Bleicher.Guarantor of overall content: R Bleicher.
This work was supported by the United States Public Health Services grant P30 CA006927 for analysis of the data via support of our biostatistics facility, and by generous private donor support from the Marlyn Fein Chapter of the Fox Chase Cancer Center Board of Associates, for analysis and interpretation of the data.
Compliance with ethical standards
Conflicts of interest
The authors have no conflicts of interest to disclose.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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