Patterns of multidisciplinary care in the management of non-metastatic invasive breast cancer in the United States Medicare patient

Purpose: Multidisciplinary care (MDC) in managing breast cancer is resource-intensive and growing in prevalence anecdotally, although care patterns are poorly characterized. We sought to determine MDC patterns and effects on care in the United States Medicare patient. Methods: Patients diagnosed with non-metastatic invasive breast cancer from 1992–2009 were reviewed using the Survival, Epidemiology, and End Results (SEER)-Medicare linked dataset. MDC was defined as a post-diagnosis, preoperative visit with a surgical, medical, and radiation oncologist. Same-day MDC (MDC_SD) was the MDC subset having all three visits on one date. Results: Among 88,865 patients, MDC was utilized in 2.9 %, with 14.1 % of these having MDC_SD. MDC use did not vary by stage, but MDC patients were more likely to be younger, black, receive lumpectomy, have fewer nodes examined, and receive radiotherapy. MDC_SD patients were more likely than non-MDC patients to be black, receive mastectomy, and receive radiotherapy. MDC and MDC_SD use increased over time and varied by geographic region, with rural patients less likely to receive MDC (OR 0.54 [95 % CI 0.45–0.65]) and MDC_SD (OR 0.32 [95 % CI 0.19–0.54]). Radiotherapy after breast conserving surgery, used in 86.5 % of non-MDC patients, was administered to 90.2 % of MDC (p = 0.001) and 92.6 % of MDC_SD (p = 0.019) patients. Post-mastectomy radiotherapy was administered in 52.0 % of non-MDC patients, 63.8 % of MDC (p = 0.050), and 89.1 % of MDC_SD (p = 0.298) after propensity score adjustment. Conclusion: While increasing, few Medicare patients undergo MDC and MDC_SD is rare. MDC may improve quality and MDC_SD should be considered for patient convenience. While not yet widespread, efforts should integrate MDC and MDC_SD across the U.S.