Neoadjuvant chemotherapy (NACT) is frequently administered to women with stage II-III breast cancer prior to surgery and can confer many benefits. One of the greatest challenges of NACT delivery is the coordination required across specialties such as surgical oncology, medical oncology, radiation oncology, radiology, and pathology. Communication gaps among these providers directly affect patients causing treatment delays, increased anxiety, and inferior outcomes. National organizations such as the National Comprehensive Cancer Network (NCCN) and our own institution- the Johns Hopkins Medical Institute (JHMI) have guidelines for the proper delivery of NACT. Despite this, in the JHMI breast cancer clinics, there are lengthy treatment delays between initial visit and initiation of NACT, significant practice variation in pre-treatment staging evaluation, and inconsistent referrals for genetic counseling. We aim to optimize delivery of NACT to patients with breast cancers who are appropriate candidates by executing a new clinical pathway at three JHMI sites- Johns Hopkins Hospital in Baltimore City, Greenspring Station in Baltimore County, and Sibley Memorial Hospital in Washington, DC. This clinical pathway will implement the NACT best practices guideline we developed internally with input from a multidisciplinary working group. Our primary aim is to determine if this pathway shortens time from first visit to first dose of NACT for our patients. We will also ascertain if our patients are getting stage-appropriate pre-treatment evaluation and timely referrals. If successful, this pathway will be disseminated to other sites within JHMI and other academic and community cancer centers.
Optimizing Delivery of Neoadjuvant Chemotherapy to Breast Cancer Patients who are Appropriate Candidates at Johns Hopkins
Johns Hopkins University
2017 Clinical Pathways in Breast Cancer