Coordinated Care in Breast Oncology: Benefits of the Multidisciplinary Clinic

In this episode of OncChats: Coordinated Care in Breast Oncology, Jason Ye, MD, and Daphne B. Stewart, MD, of Keck Medicine of USC, discuss how a multidisciplinary clinic streamlines care and improves treatment planning for patients with newly diagnosed breast cancer.

Ye: Hello, my name is Jason Ye, MD. I’m a radiation oncologist working at the Keck Medical Center and Norris Comprehensive Cancer Center of USC. I focus on breast, lung, and central nervous system malignancies. It’s a pleasure to speak on OncLive OncChats today.

Stewart: My name is Daphne Stewart, MD. I’m joining Dr Ye as his colleague. I am a medical oncologist. I focus primarily on women’s cancer, specifically breast cancer, here at the Keck Medicine School at USC. We’re here to just discuss how we work together and how we can optimize care for patients with newly diagnosed breast cancer. How do we do that, Jason? What is the way that we optimize our treatment for our patients?

Ye: For me, one of the really great pleasures of working at our institution is the multidisciplinary clinic that we have for [patients with] breast cancer. As you mentioned, when patients are newly diagnosed with breast cancer, there is just so much information to discuss, an overwhelming amount of information, and so many providers you have to see. At Keck, since around 2017 or 2018, we [gathered] all the breast cancer–related providers and put together this very nice multidisciplinary breast clinic.

To give everyone an overview of how this works: Patients will reach out to our nurse navigator, who is going to [work with them to collect] all of the necessary records, all of the available information. We currently have the multidisciplinary clinic once a week, on Mondays. Prior to the meeting, we get a summary of all external information and records that exist for the patient, and we have a morning huddle with all of the providers—surgical oncologists, medical oncologists, radiation oncologists, etc. We have a plastic surgeon on board, [or those involved with] genetic testing, and this is our core team. [We will also loop in] other providers, as needed. We have a huddle to discuss the summary of the case, and they start to think about [whether] the patient needs additional workup or what treatment we should start with. Then, when the patient shows up, they will be able to see all the necessary providers that they’re going to go through the treatment journey with—all in the same morning.

[This provides them with a really nice opportunity to really get the big picture [of what’s to come]. I’m a very big picture kind of guy; I want to know what’s going to happen—1, 2, 3, 4, 5, all the steps—before I embark on a journey. [With this,] they get to do that. They get to meet all the providers, as opposed to having to make multiple appointments on different days [and at] different locations, [which we know] gets very, very overwhelming for the patients. They will [leave] the clinic with a summary of a [potential] plan, whether it be that we need to do some additional tests or [we have outlined] the next step of treatment. I think [this provides a] really great experience to our patients and really sets [us apart].

Daphne, you’ve joined us more recently, so maybe you can speak to how this [approach] is similar or different from your previous experience?

Stewart: I’ve been at USC for about 2 years now, and one of my favorite clinical parts of my experience here is this multidisciplinary breast clinic because it is just a very, very tightly woven process. [At] other sites where I have worked, it’s been very difficult to organize operationally—specifically [in terms of] having enough space in the clinic so that you can have five providers that overlap, and that you can schedule five providers in the same half-day space. But [here] we have prioritized this amongst all of our partners on all of these teams to make it possible.

With a navigator, we have been able to schedule patients very quickly, within 14 to 21 days. Yes, there are delays sometimes because we don’t have access to outside records, and sometimes patients do, like you mentioned, require additional testing, but the patient, when they are able to be seen are able to generally be given a comprehensive forward-moving plan so that they know what the next few weeks of the treatment or interventions are going to look like. They [also] have opportunities to ask everyone specific questions. The other thing that you mentioned that I think is so effective is the huddle. When you spend 30 minutes together going through the patient [cases] and going through the side-by-side planning, we can optimize the education to the patients, so [they] have less confusion about different opinions. We’re really collaborating and making one plan going forward, which I think is really effective.

Check back tomorrow for the next episode in the series.