Improving Adherence to National Guidelines Regarding Neoadjuvant Systemic Therapy in the Management of Breast Cancer:...

Breast cancer remains one of the most frequently diagnosed cancers worldwide. There are various treatment options for breast cancer and many women will require neoadjuvant systemic therapy (NST) as part of their multi-modal treatment plan. As part of the Commission on Cancer Standard 7.2, this study assessed our institution's adherence to national guidelines in the multidisciplinary management of NST, aiming to highlight practices necessitating improvement.

A retrospective analysis included 100 patients at our institution who underwent NST between 2019 and 2023. Patients who completed NST and surgery were included in the analysis. Baseline, pre-intervention adherence to The American Society of Breast Surgeons (ASBrS) Consensus Guidelines was obtained. Using this data, three standards (Articles V, VIII, and IX) were selected to perform a quality improvement initiative. A second retrospective review was conducted of patients at the same institution from January 1, 2024 to December 31, 2024, using the same inclusion criteria as above. Adherence to the selected standards was obtained and compared to pre-intervention.

After the initial review, there were 100 female patients [average age 52.5, average body mass index (BMI) = 29.1 60% African American] who had completed NST and surgery. Of 39 ASBrS guidelines, our institution was more than 90% compliant in 74% of the categories. Compliance fell below 90% in genetic testing (88%), timing of surgery after NST (80%), repeat imaging after NST (80%), appropriate placement of surgical clips along the lumpectomy cavity (57%), delayed breast reconstruction with planned radiation (39%), and radiation initiation within six weeks of surgery (75%). Improvement initiatives focused on genetic testing, timing of surgery after NST, and repeat imaging. Interventions for each included: in-clinic saliva genetic testing with invitae and hiring a second genetic counselor; earlier coordination between medical oncology and surgery to refer patients to surgery when patients had at least two chemotherapy cycles to complete; and post-NST imaging performed at the time of surgery referral. These initiatives were implemented in December of 2023. Our second review included 30 female patients (average age 55, average BMI = 29, 57% African American) who completed NST and surgery. Compared to the pre-initiative group, our compliance with genetic testing and timing of surgery both improved to 90%. Repeat imaging post-NST improved to 89%.

Quality improvement initiatives targeting three key areas of breast cancer care over the course of one year led to improved compliance and better patient outcomes. These findings highlight the importance of a multidisciplinary team and the value of regular conferences for fostering collaboration and ensuring the most effective care for patients.