Abstract D078: Unlocking the vault: Can 2nd opinions by Comprehensive Cancer Center breast oncologists improve treatment quality for African Americans?
Authors: Pasick Rena J , Campbell Brittany , Rugo Hope S , Dillard Christen , Harris Marion , Joseph Galen 
Published: September 2020

Abstract
Research increasingly points to inadequate treatment as a factor in the excess breast cancer mortality experienced by African Americans. Likely causes include lack of guideline-concordant care, underuse of medical advances, and limited opportunities to participate in clinical trials and genetic counseling. African Americans are disproportionately affected because they are more likely to receive care in low-resource settings. Importantly, emerging research shows that NCI-designated Comprehensive Cancer Centers (CCCs) have the best cancer outcomes compared with other clinical settings - yet African Americans and Latinx are under-represented as patients in CCCs. It is as if the leading cancer clinicians and the resources at their disposal are locked in a vault inaccessible to those with the greatest need. We used ethnographic methods to explore the feasibility of and extent to which the simple mechanism of a CCC 2nd opinion can improve the quality of treatment offered to African American breast cancer patients receiving care in a range of other institutions. Through community outreach, 14 patients were recruited and 17 CCC consultations were conducted at no charge. Each visit was observed and audio-taped to capture the consulting oncologist’s recommendations. Patients were interviewed 3 weeks after the consultation and again up to 1 year later to document the impact of the consultation on their treatment. Consulting oncologists were also interviewed. Our findings reveal a variety of ways in which the CCC 2nd opinion substantially improved the quality of treatment for African American breast cancer patients. In all cases CCC clinicians offered important recommendations, from complete revision of a treatment plan to adding/changing medications, modifying the plan for monitoring, and/or improving management of side effects. Patients reported that all major recommendations were implemented by their treating clinicians. In one dramatic case, chemotherapy was failing to slow the growth a young public hospital patient’s stage 3 tumor associated with a P53 mutation. The CCC clinician recommended and advocated for an entirely different treatment. In remission two years later, the patient has had another child. To our knowledge, this is the first study to explore the CCC consultation as an intervention to reduce mortality disparities. It appears highly feasible to target CCC 2nd opinions to vulnerable patients at relatively low cost to the CCC. Many CCC clinicians are eager to see high-risk under-represented patients, and go beyond the consultation by communicating with treating clinicians and seeing patients more than once. Patients readily recognized the expertise of CCC clinicians and were deeply grateful for the opportunity. Based on this pilot study, the 2nd opinion concept warrants further testing via a randomized trial. Comprehensive Cancer Centers can and must take greater responsibility for disparities in their region through innovations that extend their expertise beyond their walls.
Citation Format: Rena J Pasick, Brittany Campbell, Hope S Rugo, Christen Dillard, Marion Harris, Galen Joseph. Unlocking the vault: Can 2nd opinions by Comprehensive Cancer Center breast oncologists improve treatment quality for African Americans? [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D078.