title: Coordination of breast cancer care between radiation oncologists and surgeons: a survey study.
abstract: OBJECTIVE
  To assess whether radiation oncologists and surgeons differ in their attitudes regarding the local management of breast cancer, and to examine coordination of care between these specialists.
  
  
  METHODS
  We surveyed attending surgeons and radiation oncologists who treated a population-based sample of patients diagnosed with breast cancer in metropolitan Detroit and Los Angeles. We identified 419 surgeons, of whom 318 (76%) responded, and 160 radiation oncologists, of whom 117 (73%) responded. We assessed demographic, professional, and practice characteristics; challenges to coordinated care; and attitudes toward management in three scenarios.
  
  
  RESULTS
  92.1% of surgeons and 94.8% of radiation oncologists indicated access to a multidisciplinary tumor board. Nevertheless, the most commonly identified challenge to radiation oncologists, cited by 27.9%, was failure of other providers to include them in the treatment decision process early enough. Nearly half the surgeons (49.7%) stated that few or almost none of the breast cancer patients they saw in the past 12 months had consulted with a radiation oncologist before undergoing definitive surgery. Surgeons and radiation oncologists differed in their recommendations in management scenarios. Radiation oncologists were more likely to favor radiation than were surgeons for a patient with 3/20 lymph nodes undergoing mastectomy (p = 0.03); surgeons were more likely to favor more widely clear margins after breast conservation than were radiation oncologists (p = 0.001).
  
  
  CONCLUSIONS
  Despite the widespread availability of tumor boards, a substantial minority of radiation oncologists indicated other providers failed to include them in the breast cancer treatment decision-making process early enough. Earlier inclusion of radiation oncologists may influence patient decisions, and interventions to facilitate this should be considered.
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA. rjagsi@med.umich.edu
authors.forename: Reshma
authors.initials: R
authors.lastname: Jagsi
authors.forename: Paul
authors.initials: P
authors.lastname: Abrahamse
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
authors.forename: Ann S
authors.initials: AS
authors.lastname: Hamilton
authors.forename: John J
authors.initials: JJ
authors.lastname: Graff
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Katz
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D003657:Decision Making; D005260:Female; D013502:General Surgery; D006801:Humans; D033183:Interdisciplinary Communication; D015141:Los Angeles; D008297:Male; D008824:Michigan; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D018802:Patient-Centered Care / Q000458:organization & administration; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D018787:Radiation Oncology; D013044:Specialty Boards / Q000706:statistics & numerical data; D055815:Young Adult