Abstract P4-11-05: Improving neoadjuvant breast cancer therapy rates uptake with education and technology
Authors: Gary M , Keeler V , Rush S , Parsons P , Zhong X , Stricker CT , Wujcik D , DiGiovanni L , Davis A , Han LK 
Published: February 2018

Abstract
Background: Recent studies show that treating aggressive subtypes of breast cancer (BC) with neoadjuvant chemotherapy (NAC) improves clinical outcomes in addition to breast conservation therapy (BCT) rates. Yet a large multi-site population-level analysis shows that only 5.5% of NCCN-guideline eligible patients receive NAC (Ontilo et al, 2013). Multi-level interventions are needed to improve concordance with NCCN guidelines for NAC consideration in women who meet criteria for BCT (clinical stage IIA, IIB, and IIIA BC). Methods: A 2-part intervention was undertaken to improve adherence to NAC guidelines. Certified medical education (CME) was first provided on BC diagnostics and treatment (Tx), including NAC. Next patients were recruited to a point of care technology-based intervention. Eligibility included a new diagnosis of invasive BC, clinical stage T1c and/or N1 or greater, and no prior Tx. Patients interact with an electronic care planning system (CPS) at the time of surgical consultation to report preferences for decision-making and concerns, such as distress over losing a breast. The CPS displays these findings along with a draft care plan (CP) that suggests guideline based referrals and provides patient education about BC diagnosis and Tx options. After editing, surgeons finalize and deliver CPs at the visit. The goal is to describe referral rates to medical oncology for discussion of and receipt of NAC. Outcomes from chart abstraction are compared to historical rates in the literature and where available, the institution. Results: Data on 39 of 75 women are mature (remaining to be presented at meeting). Median age is 60 years (range 37-92) and clinical stage is IA=41% (N=16), IIA= 41% (N=16), IIB=8% (N=3), and III=10% (N=4). Of 39 patients, 44% were HR+HER2+, 10% were HR+HER2-, 13% had triple negative BC, and 33% had incomplete data. Per NCCN stage, 59% (N =23) were eligible for NAC evaluation. 96% (N=22) of those eligible were referred to MO. Follow up 2 months post-surgical appointment revealed 91% (N=21) of referred patients had completed a MO consultation. 39% (N=9) of those referred for evaluation (N=23) had a prescription for NAC and all prescriptions were guideline adherent, including regimens combining chemotherapy with trastuzumab and pertuzumab for HER2+ disease. Overall, 30.4% of women eligible for referral went on to receive NAC. Distress related to loss of breast was moderate (0-10 scale, M=4.83) and was significantly related to whether patients received a referral for NAC (B= -.304, Wald's=4.61, p=.03). Most of participating providers (80%, N=5) felt the CP was valuable to help with Tx decision-making. Conclusions: Preliminary results show CME and an electronic CPS may improve NAC uptake. Rates of prescription were clearly higher in this analysis than in a 4-center population database study, both overall (23.1% vs. 3.8%) and by NCCN eligibility (30.4% vs. 5.5%), and compared to baseline in 1 (of 3 planned) centers in the study who had a baseline rate of overall NAC prescription of 8.7% in the year prior to the study. The higher the distress over the loss of a breast, the more likely the patient received a referral for NAC. These data provide preliminary support for improving NAC uptake and warrant investigation in a RCT.
Citation Format: Gary M, Keeler V, Rush S, Parsons P, Zhong X, Stricker CT, Wujcik D, DiGiovanni L, Davis A, Han LK. Improving neoadjuvant breast cancer therapy rates uptake with education and technology [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 P4-11-05.