Patterns of multidisciplinary care in the management of non-metastatic invasive breast cancer in the United States Medicare patient

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 (MDC_SD) 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 MDC_SD. 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. MDC_SD patients were more likely than non-MDC patients to be black, receive mastectomy, and receive radiotherapy. MDC and MDC_SD use 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 MDC_SD (OR 0.32 [95 % CI 0.19–0.54]). Radiotherapy after breast conserving surgery, used in 86.5 % of non-MDC patients, was administered to 90.2 % of MDC (p = 0.001) and 92.6 % of MDC_SD (p = 0.019) 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 = 0.298) after propensity score adjustment.

While increasing, few Medicare patients undergo MDC and MDC_SD is rare. MDC may improve quality and MDC_SD should be considered for patient convenience. While not yet widespread, efforts should integrate MDC and MDC_SD across the U.S.