title: A Multidisciplinary Breast Cancer Brain Metastases Clinic: The University of North Carolina Experience.
abstract: BACKGROUND
  Breast cancer brain metastasis (BCBM) confers a poor prognosis and is unusual in requiring multidisciplinary care in the metastatic setting. The University of North Carolina at Chapel Hill (UNC-CH) has created a BCBM clinic to provide medical and radiation oncology, neurosurgical, and supportive services to this complex patient population. We describe organization and design of the clinic as well as characteristics, treatments, and outcomes of the patients seen in its first 3 years.
  
  
  METHODS
  Clinical and demographic data were collected from patients in a prospectively maintained database. Descriptive statistics are reported as percentages and means. The Kaplan-Meier method was used to estimate time-to-event outcomes.
  
  
  RESULTS
  Sixty-five patients were seen between January 2012 and January 2015. At the time of presentation to the BCBM clinic, most patients (74%) had multiple (≥2) brain metastases and had received prior systemic (77%) and whole-brain radiation therapy and/or central nervous system stereotactic radiosurgery (65%) in the metastatic setting. Seventy-eight percent returned for a follow-up visit; 32% were enrolled in a clinical trial. Median time from diagnosis of brain metastasis to death was 2.11 years (95% confidence interval [CI] 1.31-2.47) for all patients, 1.15 years (95% CI 0.4-2.43) for triple-negative breast cancer, 1.31 years (95% CI 0.51-2.52) for hormone receptor-positive/HER2- breast cancer, and 3.03 years (95% CI lower limit 1.94, upper limit not estimable) for HER2+ breast cancer (p = .0037).
  
  
  CONCLUSIONS
  Patients with BCBM have unique and complex needs that require input from several oncologic disciplines. The development of the UNC-CH multidisciplinary BCBM clinic is a model that can be adapted at other centers to provide coordinated care for patients with a challenging and complex disease.
  
  
  CONCLUSIONS
  Patients with breast cancer brain metastases often require unique multidisciplinary care to meet the numerous and uncommon challenges associated with their conditions. Here, the development and characteristics of a clinic designed specifically to provide for the multidisciplinary needs of patients with breast cancer brain metastases are described. This clinic may serve as a model for other institutions interested in creating specialty clinics with similar objectives.
authors.affiliation: Atlanta Cancer Care, Atlanta, Georgia, USA University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA Department of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Megan J
authors.initials: MJ
authors.lastname: McKee
authors.affiliation: University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Keith
authors.affiliation: University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Deal
authors.affiliation: University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Garrett
authors.affiliation: University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA.
authors.forename: Amy A
authors.initials: AA
authors.lastname: Wheless
authors.affiliation: Department of Radiation Oncology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Green
authors.affiliation: University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Benbow
authors.affiliation: University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA Department of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: E Claire
authors.initials: EC
authors.lastname: Dees
authors.affiliation: University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA Department of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Carey
authors.affiliation: University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA Department of Neurosurgery, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Ewend
authors.affiliation: University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA Department of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA carey_anders@med.unc.edu.
authors.forename: Carey K
authors.initials: CK
authors.lastname: Anders
authors.affiliation: University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA Department of Radiation Oncology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA Department of Neurosurgery, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Zagar
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009657:North Carolina; D011379:Prognosis; D016634:Radiosurgery; D016896:Treatment Outcome
keywords: Brain metastases; Breast cancer; Clinic; Multidisciplinary