Abstract P4-10-04: EMBRACE (Ending metastatic breast cancer for everyone): A comprehensive approach to improve the care of patients with metastatic breast cancer
Authors: Hughes ME , Frank ES , Merrill MS , Santiago RA , Kuhnly N , Crowley LM , Gupta G , Winer EP , Lin NU 
Published: February 2018

Background: In contrast to early stage breast cancer, the quality of care for patients with metastatic breast cancer (MBC) has been relatively understudied, as have interventions to improve care in the real-world setting. Patients with MBC face a variety of unique needs related to their disease, treatment options, and supportive care. Little attention has been focused on leveraging the strengths of academic and community-based settings to provide optimal care for these patients. To address these critical issues, we have designed and implemented a comprehensive program that combines clinical care, clinical research, physician engagement and patient education to optimize the care of MBC patients.

Methods: We developed a consistent and comprehensive intake process and follow-up approach for MBC patients who were seen at least once in the Breast Oncology Clinic (BOC) at Dana-Farber Cancer Institute (DFCI). A key component of our approach is the EMBRACE coordinator who meets with each MBC patient at the first clinic visit to review the clinical program, available educational and supportive resources, and consents to research studies. Each coordinator supports the DFCI-based oncologist and follows a discrete patient panel longitudinally, for whom they are responsible for facilitating referrals to supportive care resources, identifying potential candidates for trial prescreening, tracking availability of results from molecular testing for clinical trial matching, facilitating communication between DFCI-based providers and referring providers and organizing re-consultation visits when clinically appropriate. The coordinator contacts patients every 3 months to inquire about the patient's overall health and needs and provides updates on upcoming educational and supportive care activities at our institution. Educational offerings have been expanded to include a bi-annual newsletter, quarterly email updates, webcasts and an annual educational patient forum. Results: The program was fully implemented in the BOC across 27 oncologists in August 2016, after the start of a pilot in July 2015. On average, the program enrolls 30 to 40 new MBC patients per month at their initial visit. The EMBRACE coordinators currently support the DFCI-based oncologists in the care of approximately 1500 new and existing MBC patients and facilitate collaborations with 350 referring providers.

Conclusions: The EMBRACE program has made a tangible improvement in the quality of care for patients with MBC in our clinic. We have successfully established the infrastructure of the coordinator role and a robust tracking system to support the patient, DFCI-based provider, and referring provider. While the program has been solely based at DFCI, we believe that our approach has the potential for impact beyond our institution and ultimately serve as a model for enhanced academic-community-patient partnership.

Citation Format: Hughes ME, Frank ES, Merrill MS, Santiago RA, Kuhnly N, Crowley LM, Gupta G, Winer EP, Lin NU. EMBRACE (Ending metastatic breast cancer for everyone): A comprehensive approach to improve the care of patients with metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-04.