A Multidisciplinary Breast Cancer Clinic Improves Time to Treatment at an Urban, Safety Net Hospital.

Abstract

Background: Socioeconomically vulnerable patients experience significant breast cancer care treatment disparities. Our aim was to examine how multidisciplinary breast cancer clinic (MBCC) implementation affected time to treatment at a safety net hospital.

Methods: This was a retrospective cohort study of female patients (≥18 years) with new breast cancer diagnoses from January 2019-September 2022. Time to treatment from biopsy-confirmed diagnosis was compared between patients seen in MBCC and those in a traditional discipline-based serial episodic clinic model.

Results: Among 734 patients (mean age 58.5 years), 45.8% identified as Black and 48.4% were insured by Medicaid. MBCC patients (28.9%) were younger (55.7 vs. 59.6 years, P<0.001), less likely to be Hispanic (18.4% vs. 27.6%, P=0.01), more likely to have invasive cancer (86.8% vs. 60.3%, P<0.001), had shorter time to treatment (35.0 vs. 46.9 days, P<0.001), and were more likely to receive chemotherapy first (48.6% vs. 11.5%, P<0.001) compared to non-MBCC patients. In patients who received chemotherapy first, MBCC was associated with reduced time to initial appointment (10.2 vs. 18.1 days, P=0.011) and treatment initiation (27.1 vs. 42.6 days, P<0.001). Multivariable analysis showed invasive histology was associated with MBCC participation (OR 4.29, P<0.0001), while Hispanic ethnicity (OR 0.55, P=0.014) and older age (OR 0.98, P=0.021) were less associated with MBCC.

Conclusions: Implementation of a MBCC in a safety net hospital improved time to initial breast cancer treatment for vulnerable patients. Moving forward, MBCC can serve as a model to reduce disparities in vulnerable patient populations.