title: Patterns of multidisciplinary care in the management of non-metastatic invasive breast cancer in the United States Medicare patient.
abstract: 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. MDCSDpatients were more likely than non-MDC patients to be black, receive mastectomy, and receive radiotherapy. MDC and MDCSDuse 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 86.2 % of non-MDC patients, was administered to 90.2 % of MDC (p < 0.001) and 92.6 % of MDC(SD) (p = 0.096) patients. Post-mastectomy radiotherapy was administered in 52.0 % of non-MDC patients, 63.8 % of MDC (p = 0.050), and 89.1 % of MDC(SD) (p = 0.011) patients after propensity score adjustment.
  
  
  
  While increasing, few Medicare patients undergo MDC and MDCSDis rare. MDC may improve quality and MDCSDshould be considered for patient convenience. While not yet widespread, efforts should integrate MDC and MDCSDacross the U.S.
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Churilla
authors.affiliation: Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Egleston
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
authors.forename: Colin T
authors.initials: CT
authors.lastname: Murphy
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Room C-308, Philadelphia, PA, 19111, USA.
authors.forename: Elin R
authors.initials: ER
authors.lastname: Sigurdson
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
authors.forename: Shelly B
authors.initials: SB
authors.lastname: Hayes
authors.affiliation: Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Goldstein
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Room C-308, Philadelphia, PA, 19111, USA. richard.bleicher@fccc.edu.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bleicher
mesh_terms: D001943:Breast Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006278:Medicare; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D005791:Patient Care; D010348:Patient Care Team; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D018426:SEER Program; D014481:United States / Q000453:epidemiology
keywords: Breast cancer; Medical oncology; Multidisciplinary care; Radiation oncology; Surgical oncology