Multidisciplinary Breast Cancer Clinic Improves Time to First Treatment

Utilizing a multidisciplinary breast cancer clinic helped improve time to first appointment and time to first treatment.

The improvement of time to initial breast cancer treatment for patients classified as vulnerable was noted in safety net hospitals where the implementation of a multidisciplinary breast cancer clinic (MBCC) occurred, according to a press conference presentation from the 26th Annual Meeting of the American Society of Breast Surgeons.

In the MBCC group, the time to first appointment was 11.3 days ± 10.1 vs 12.7 days ± 14.5 in the non-MBCC group (P = .21). The time to first treatment was 35.0 days ± 25.9 in the MBCC group vs 46.9 days ± 47.3 in the non-MBCC group (P <.001). Additionally, 13.2% of patients in the MBCC group had non-invasive disease vs 86.8% who had invasive disease compared with the non-MBCC group, in which 39.7% vs 60.3% had non-invasive or invasive disease, respectively.

“Moving forward, [MBCC] can serve as a model to reduce disparities in vulnerable patient populations,” Anna J. Kobzeva-Herzog, MD, a general surgery resident at Boston Medical Center, said during the presentation.

Overall, 734 patients were enrolled between January 2019 and September 2022. The outcomes seen with the MBCC model implemented in January 2019 were compared with those of the traditional discipline-based serial episodic clinic model.

In the MBCC group (n = 212), the mean patient age was 55.7 years ± 14.7 vs 59.6 years ± 12.4 in the non-MBCC group (n = 522; P <.001). Of note, 98.1% vs 99.2% were female (P = .190), 41.0% vs 45.6% were White, 49.5% vs 44.3% were Black, and 6.1% vs 5.2% were Asian. Additionally, the authors highlighted Hispanic ethnicity as significant, with 18.4% of patients identifying as Hispanic in the MBCC group vs 27.6% in the non-MBCC group (P = .01).

Insurance types between the MBCC and non-MBCC groups included Medicaid (50.5% vs 47.5%), Medicare (17.5% vs 26.2%), private (31.1% vs 24.1%), or unknown/no insurance (2.0% vs 2.1%).

The type of first treatment was also recorded for the MBCC and non-MBCC groups, which included surgery (43.4% vs 77.2%; P <.001), chemotherapy (48.6% vs 11.5%; P <.001), endocrine therapy (8.5% vs 10.2%; P = .49), and radiation (0.0% vs 1.0%; P = .15).

For patients who received chemotherapy first, the time to first appointment was 10.3 days ± 10.2 in the MBCC group vs 18.1 days ± 27.9 in the non-MBCC group (P = .011), while the time to first treatment was 27.1 days ± 16.9 vs 42.6 days ± 40.3 (P <.001). For patients who received surgery first, the time to first appointment was 12.8 days ± 10.9 in the MBCC group vs 11.5 days ± 9.6 in the non-MBCC group (P = .26), and the time to first treatment was 46.0 days ± 27.4 vs 45.7 ± 29.5 (P = .92).

The multivariate logistic regression model found invasive histology (OR, 4.29; 95% CI, 2.75-6.68; P <.0001) showed increased odds of being seen at a MBCC, while age (OR, 0.98; 95% CI, 0.97-0.99; P = .021) and Hispanic ethnicity (OR, 0.55; 95% CI, 0.34-0.88; P = .014) were associated with decreased odds.

The aim of this study was to assess the effect of MBCC visits and the treatment of patients at a safety net hospital. Kobzeva-Herzog noted that those who are minorities or underinsured have a longer time to treatment based on the current literature.

Patients who were 18 years or older, female, and had a new breast cancer diagnosis through the cancer registry of Kobzeva-Herzog’s institution were included in the trial.

Reference

Kobzeva-Herzog AJ, Palaniappan S, Jiangliu Y, et al. Evaluating the effect of a multidisciplinary breast cancer clinic on time to treatment at an urban safety net hospital. Presented at a press conference for the American Society of Breast Surgeons; April 24, 2025.