School of Medicine, Johns Hopkins University, 4940 Eastern Ave, Room A-562, Baltimore, MD, 21224, USA.
Women's Malignancies Disease Group, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA.
Breast Cancer Res Treat. 2020 Aug;182(3):623-629. doi: 10.1007/s10549-020-05721-3. Epub 2020 Jun 8.
A delay in breast cancer treatment is associated with inferior survival outcomes; however, no clear guidelines exist defining the appropriate time frame from diagnosis to definitive treatment of breast cancer. A multidisciplinary approach for breast cancer treatment can minimize the time from diagnosis to first treatment. We hypothesized single-day multidisciplinary clinic (MDC) may accelerate the time to first treatment on complex breast cancer cases at our institution.
We identified patients who were treated at Johns Hopkins for stage II or III breast cancer, who were at least 18 years of age, and were seen in a new single-day MDC with coordination between two or three specialties or by specialists from varying disciplines on different days (IDC). Patients who initiated treatment between May 2015 (initiation of MDC clinic) and December 2017 were included in our study.
A total of 296 patient records were reviewed independently. The mean (SD) patient age was 55 (13) years. The median time to first neoadjuvant chemotherapy (NACT) was significantly reduced for patients seen in the MDC (12.7 days), compared to those seen at the IDC (24.4 days, logrank p < 0.001). The median time to definitive surgery was similar between groups (31 and 32 days for the MDC and IDC cohorts, respectively).
A single-day MDC visit is associated with a reduced time from diagnosis to NACT. Further studies are needed to determine if a shorter interval can improve the management and the outcome of complex breast cancer cases.
乳腺癌治疗的延误与较差的生存结果相关；然而，目前尚不存在明确的指南来定义从诊断到乳腺癌确定性治疗的适当时间框架。采用多学科方法治疗乳腺癌可以最大程度地缩短从诊断到首次治疗的时间。我们假设在我们的机构中，单天多学科诊所（MDC）可能会加速复杂乳腺癌病例的首次治疗时间。
我们确定了在约翰霍普金斯医院接受 II 期或 III 期乳腺癌治疗的患者，年龄至少 18 岁，在新的单天 MDC 中就诊，该 MDC 由两个或三个专业科室协调，或在不同的日子由不同学科的专家就诊（IDC）。我们的研究纳入了自 2015 年 5 月（MDC 诊所开设）至 2017 年 12 月期间开始治疗的患者。
共回顾了 296 份患者记录。患者的平均（SD）年龄为 55（13）岁。与 IDC 就诊的患者（24.4 天，对数秩检验 p<0.001）相比，在 MDC 就诊的患者首次新辅助化疗（NACT）的中位时间明显缩短（12.7 天）。两组患者的确定性手术中位时间相似（MDC 和 IDC 队列分别为 31 天和 32 天）。
单天 MDC 就诊与从诊断到 NACT 的时间缩短相关。需要进一步的研究来确定更短的间隔是否可以改善复杂乳腺癌病例的管理和结局。
