Winship Clinicians Receive Grant to Improve Patient and Provider Adherence to Breast Cancer Treatments

March 2018

Preeti Subhedar, MD, a breast surgical oncologist of the Emory Department of Surgery based at Grady Memorial Hospital, and Mylin Torres, MD, radiation oncologist and director of the Glenn Family Breast Center of Winship Cancer Institute, have received a two-year, $250,000 research award from the National Comprehensive Cancer Network (NCCN) and Pfizer Global Medical Grants for their study, "Care Pathway Development, Implementation and Assessment to Improve Outcomes in African American Breast Cancer Patients."

The grant is the product of a new funding opportunity offered by NCCN and Pfizer for projects that use clinical care pathways to address quality improvement initiatives along the continuum of care for breast cancer patients. Of the more than 90 letters of intent that were submitted to the NCCN and Pfizer's Request for Proposal Committee, 23 proposals were selected for review. Of these, only nine institutions—including Johns Hopkins Medicine, Northwestern University Feinberg School of Medicine, Roswell Park Alliance Foundation, and Emory—were granted funding for their projects.

Dr. Subhedar and Dr. Torres' study is a step in redressing the fact that African American women in Atlanta display the most pronounced racial disparities for outcomes in breast cancer compared with the top 50 largest metropolitan areas in the United States. They have more delays in treatment, lower rates of adherence to adjuvant therapies including radiation and chemotherapy, and lower rates of referrals for genetic testing.

"Clinical care pathways have been demonstrated across institutions and disciplines to increase adherence to care and improve long term outcomes," says Dr. Subhedar. "Patients within a system with care pathways are more likely to undergo adjuvant chemotherapy and radiation within an appropriate timeframe, and to comply with other breast cancer quality metrics as recommended by such national guidelines as the NCCN."

Last year, Dr. Torres and her colleagues at the Glenn Family Breast Center created a clinical care pathway for patients undergoing neoadjuvant chemotherapy. A pre-implementation audit noted that two metrics fell below 75 percent: referral for clinical trials and referral for adjuvant radiation. Before the clinical care pathway went into effect, the audit results were released and Winship care teams were made aware of the improvement goals, after which there was a 10 percent increase in adherence to these two metrics when the pathway became active.

Evolving from this initiative, Drs. Subhedar and Torres will work with Winship's multidisciplinary breast team to develop and initiate stage and treatment-specific breast cancer algorithms across all Winship and Grady Memorial Hospital cancer sites. With assistance provided by the Emory IT department, key elements from these algorithms will be integrated into the electronic medical record to serve as automatic reminders of treatment compliance and alert the healthcare team when a patient is at risk for treatment non-adherence. Nurse navigators will also be trained to intervene to ensure compliance with multimodality treatment.

Over the two-year span of the grant, Dr. Subhedar and Dr. Torres hope to increase both patient and provider compliance with treatment, in an effort to reduce the breast cancer treatment disparity that is seen in Atlanta's most vulnerable population.

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