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Coordination of Breast Cancer Care Between Radiation Oncologists and Surgeons: A Survey Study
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Details:
  • Pubmed ID:
    21477932
  • Pubmed Central ID:
    PMC4373416
  • Funding:
    K05CA111340/CA/NCI NIH HHS/United States
    N01-PC-35145/PC/NCI NIH HHS/United States
    R01 CA088370/CA/NCI NIH HHS/United States
    N01 PC035139/PC/NCI NIH HHS/United States
    N01-PC-35139/PC/NCI NIH HHS/United States
    K05 CA111340/CA/NCI NIH HHS/United States
    U58 DP000807/DP/NCCDPHP CDC HHS/United States
    N01PC54404/CA/NCI NIH HHS/United States
    N01PC35145/CA/NCI NIH HHS/United States
    N01PC35139/CA/NCI NIH HHS/United States
    N01-PC-54404/PC/NCI NIH HHS/United States
    R01 CA109696/CA/NCI NIH HHS/United States
  • Document Type:
  • Collection(s):
  • Description:
    Purpose

    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 and Materials

    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.