Are some surgeons merely paying lip service to collaborative, multidisciplinary decision making? Radiation oncologists often were excluded from early steps in the breast cancer treatment decision-making process, leaving some patients uninformed of all of their treatment options and potentially leading to more mastectomies over breast-conserving therapy, according to a study published in this month's International Journal of Radiation Oncology•Biology•Physics.
Multidisciplinary collaboration is emerging as the standard in cancer care. Women with breast cancer face many complex decisions regarding treatment, including the extent of primary surgery and whether or not to receive adjuvant radiotherapy.
Although radiation oncologists and surgeons may differ in their recommended approaches to treatment, few studies have examined the frequency and timing of consultation between surgeons and radiation oncologists.
Reshma Jagsi, MD, of the department of radiation oncology at University of Michigan in Ann Arbor, and colleagues designed and administered a survey to answer four questions:
- When do radiation oncologists become involved in the care of patients with newly diagnosed breast cancer?
- Do radiation oncologists believe they are involved in breast cancer patients’ care at the appropriate time in the decision-making process?
- Are provider or practice characteristics associated with more coordinated multidisciplinary care?
- Do surgeons and radiation oncologists have different opinions regarding optimal management in certain common breast cancer scenarios?
Jagsi and colleagues identified 419 surgeons and 160 radiation oncologists who treated a population-based sample of patients diagnosed with breast cancer in Detroit and Los Angeles. A total of 76 percent of surgeons and 73 percent of radiation oncologists responded to the survey.
Although 92 percent of surgeons and 95 percent of radiation oncologists reported access to a multidisciplinary tumor board, 28 percent of radiation oncologists said other providers failed to include them in the treatment decisions early enough.
This perception is reflected in responses from surgeons. Nearly half said that few or none of the breast cancer patients they saw in the past 12 months had consulted with a radiation oncologist prior to undergoing definitive surgery, and approximately 25 percent of surgeons said they had discussed two-thirds or more of their breast cancer cases with a radiation oncologists prior to definitive surgery, according to Jagsi et al.
Radiation oncologists’ responses were similar. In addition to a gap in early collaborative decision making, radiation oncologists cited barriers to collaboration with other physicians. At least one-fifth of respondents reported the following challenges:
- Arranging to discuss patients’ treatment plans with a plastic surgeon;
- Arranging to have a mammogram exams reviewed by a radiologist; and
- Arranging to have pathology slides reviewed by a pathologist.
The researchers noted differences in preferred treatments among surgeons and radiation oncologists. “Radiation oncologists were more likely to advocate for postmastectomy radiation therapy for a patient with N1 disease, and surgeons were more likely to require wider margins of resection for breast-conserving therapy.”
Jagsi and colleagues suggested that the findings may “highlight a potential area for quality improvement in breast cancer care … [and] help motivate surgeons to consult with their radiation oncology colleagues earlier.” Finally, the researchers concluded that increased availability of same-day multidisciplinary clinics could improve radiation oncologists’ participation in decision making.