title: Access to multidisciplinary cancer care: is it linked to the use of breast-conserving surgery with radiation for early-stage breast carcinoma?
abstract: BACKGROUND
  Breast-conserving surgery (BCS) with radiation (BCSR) requires a multidisciplinary care approach between surgeons and radiation oncologists.
  
  
  METHODS
  This retrospective cohort study examined the use of preoperative radiation oncology consultation and whether use of or distance to this care was associated with treatment choice among 1188 women age > or = 65 years who were diagnosed with local or regional breast carcinoma in Washington State in 1994 and 1995. Study outcomes included rates of BCSR; BCS alone; and mastectomy; and radiation therapy among women who underwent BCS.
  
  
  RESULTS
  Only 29% of patients in the current study consulted with a radiation oncologist preoperatively, and less than half of the patients (46.6%) consulted with either a medical oncologist or a radiation oncologist. Among women who underwent either BCSR or mastectomy, the odds of undergoing BCSR among women who had a preoperative radiation oncology consultation were 6.7 times the odds of women who did not have the consultation (P < or = 0.001). Similarly, the odds of receiving radiation therapy among women who underwent BCS and had a preoperative radiation oncology consultation were 5 times the odds of women who did not have the consultation (P < 0.001). The 3.4% of women who lived > 50 miles from the radiation therapy center had the lowest BCSR rate (15.8%) and had the lowest radiation therapy rate among women who underwent BCS (54.5%), although these findings were not statistically significant in adjusted analyses.
  
  
  CONCLUSIONS
  A preoperative visit with a radiation oncologist was associated strongly with BCSR use. More should be done to evaluate the role of multidisciplinary consultation in the decision to use BCSR.
authors.affiliation: Department of Family Medicine, University of Washington, Seattle, Washington 98195-4696, USA. lmb@fammed.washington.edu
authors.forename: Laura-Mae
authors.initials: LM
authors.lastname: Baldwin
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Taplin
authors.forename: Harvey
authors.initials: H
authors.lastname: Friedman
authors.forename: Roger
authors.initials: R
authors.lastname: Moe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D015412:Mastectomy, Segmental; D006278:Medicare / Q000706:statistics & numerical data; D009367:Neoplasm Staging; D016017:Odds Ratio; D010348:Patient Care Team; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D018714:Radiotherapy, Adjuvant; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018426:SEER Program / Q000706:statistics & numerical data; D014861:Washington