P2-16-02: How Well Do Medical Oncologists and Plastic Surgeons Communicate about Their Patients?
Authors: Milucky JL , Deal A , Wu R , McNally RS , Anders C , Lee C 
Published: June 2012

Background: While complications of post-mastectomy breast reconstruction can affect the timing of adjuvant chemotherapy, chemotherapy can affect the wound healing process after reconstruction. Due to this interdependence, adequate communication between medical oncologists (MO) and plastic surgeons (PS) may be critical to optimize patient outcomes. In this study, we sought to evaluate the knowledge MO and PS have of each other's fields, the roles they expect of each other, and how often they communicate in treating breast reconstruction patients.

Methods: A cross-sectional survey was conducted in a convenience sample of MO who treat at least one breast cancer (BC) patient per month and PS who perform at least one breast reconstruction per year. Surveys were distributed via email, US mail, and at two professional meetings. The survey included knowledge questions about reconstruction and chemotherapy, questions about provider and patient responsibilities for timely chemotherapy initiation, and questions about communication with other specialties. Fisher's Exact and Wilcoxon Rank Sum tests were used to compare differences between groups.

Results: 53 medical oncologists and 23 plastic surgeons completed surveys (51% response rate). MO and PS had similar overall knowledge scores (MO 59%, PS 56%, p=0.5). 23% of MO knew the correct treatments for breast skin necrosis, and 60% knew the correct treatment for seromas. 32% of PS knew the approximate duration of Her2-directed therapy, and 14% of PS identified the usual adjuvant treatment for patients who have had neoadjuvant chemotherapy. Providers from both specialties who primarily practice in a rural setting scored significantly lower on the knowledge portion of the survey than those practicing in an academic medical center or urban/suburban area (51% rural versus 59%, p=0.03).

The MO and PS agreed on the MO's degree of responsibility for timely chemotherapy initiation (MO mean 4.6 versus PS mean 4.4 out of 5, p =0.2). However, they disagreed about the PS's responsibility for timely chemotherapy initiation (MO mean 3.8, PS mean 3.0 out of 5, p=0.01).

MO attributed low importance to a history of immediate breast reconstruction when planning chemotherapy treatment (mean 2.5 out of 10). PS placed little importance on the likelihood of post-operative chemotherapy when planning immediate breast reconstruction (mean 3.6 out of 10). Both MO and PS reported more frequent communication with each other about patients with complications than about uncomplicated patients (mean 3.9 times over first 6 month for complications versus mean 1.6 over first 6 months for uncomplicated). This translated to communicating about 2.5 times as often for complicated patients (p&lt;0.001).

Conclusion: Medical oncologists and plastic surgeons have substantial deficits in knowledge about each other's fields and differ in their opinion regarding the burden of responsibility in ensuring timely chemotherapy initiation. While MO and PS increase their communication when complications arise, these data suggest room for improvement in communication and understanding, which could improve the care of BC patients who undergo reconstruction and chemotherapy.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-16-02.