Abstract P4-10-03: Compliance improvement with enhanced, patient-specific breast clinic infrastructure
Authors: Carandang MI , Wagman LD , Babaran W 
Published: May 2016

Background: NCCN provides guidelines for breast cancer post-therapy surveillance (clinic appointments, mammograms, and anti-hormone therapy use). The multidisciplinary breast care clinic (MDC) was designed with a specific infrastructure to serve women with state-federal safety net funding. The purpose of this study was to determine patient compliance in this population.

Methods: A retrospective chart review was performed on 82 previously diagnosed breast cancer subjects seen at the MDC during 2011-13. Post-therapy surveillance compliance for clinic appointments (CA, n=82), annual mammography for subjects with one or both breasts intact (MAM, n=75), and yearly evaluation for subjects prescribed anti-hormone therapy (AHT, n=61) was assessed. Compliance was compared based on subject characteristics: age, stage, distance from home to MDC, insurance carrier, race, and ethnicity.

Results: The per patient average combined compliance for all post-therapy surveillance was 87.7% at 12 months, 57% at 18 months, and 76.9% at 60 months. There were no trends in the analysis of average of CA kept based on insurance carriers. HMO participants had the highest percentage compliance at (95.0%; n= 2). After that, the ranking was as follows: 73.7% of those who are under the Breast Cancer Early Detection Program (BCEDP) (n=9), 68.6% under Cal Optima (n= 63), 68.2% straight Medicare (n= 2), and 63.1% for subjects with MediCal (n= 6). While no trend was identified for MAM by insurance carrier, the compliance was overall higher (average of 90%) when compared to CA (average of 74%) and AHT compliance (average of 87%). The overall cumulative percent compliance by test category and characteristic groups was:

 Age(in years)StageDistance(in miles)EthnicityRaceCA30-39: 700: 59.30-9.9: 70.6White: 67.8Non-Spanish: 70.7 40-49: 71.51: 71.210-19.9: 69.4Asian: 72.3Spanish: 65.2 50-59: 66.72: 64.420+: 67.6Other: 68  60-69: 70.43: 80.6     4: 77.3   MAM30-39: 900: 87.70-9.9: 88White: 87Non-Spanish: 87.6 40-49: 80.11: 90.610-19.9: 93.5Asian: 90.1Spanish: 90.1 50-59: 922: 85.120+: 81Other: 86.7  60-69: 86.73: 89.6     4: 91.7   AHT30-39: 87.50: 73.10-9.9: 80.3White: 78Non-Spanish: 78.4 40-49: 78.31: 78.610-19.9: 75.2Asian: 80.4Spanish: 76.5 50-59: 74.22: 76.220+: 77.5Other: 52.5  60-69: 82.63: 81.4     4: 83.3   

Conclusions:

Given the perceived challenge of consistent, reliable follow up in this patient population, the results of this analysis are quite encouraging with averages for mammogram at 87%, AHT compliance of 76%, and CA at 68%. The compliance patterns discovered in this evaluation document the expectations and serve as a real-life practical, community standard. Mammography emerged as a driving component of compliance. The overall average combined compliance reduction at 18 months may be associated with possible visits to non-MDC facilities when mammography was not performed. An attempt to define outlier groups for potential infrastructure modification, based on unique group characteristics, was unsuccessful. While this may be attributed to the small n values, an alternate explanation is that the consistent infrastructure designed for a diverse, underinsured population resulted in a lack of variation.

Citation Format: Carandang MI, Wagman LD, Babaran W. Compliance improvement with enhanced, patient-specific breast clinic infrastructure. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-10-03.