Missed Opportunities in Breast Cancer Treatment

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Despite the fact that adjuvant therapies for breast cancer--supplementary treatments like radiotherapy, chemotherapy, or hormonal therapy--can increase the chances of survival, many women do not receive them.

While in some cases patients decline treatment, or physicians do not recommend it, many other women simply slip through the cracks of the health care system. In a Commonwealth Fund-supported study, researchers at the Mount Sinai School of Medicine and Rutgers University term these missed opportunities "system failures" — breakdowns that occur despite surgeons' recommendation for treatment and patients' willingness to
receive it.

Overall, one-third of women in the study did not receive adjuvant therapies for breast cancer due to such breakdowns. System failures are even more common among vulnerable women, say the authors. Minority women and women receiving Medicaid were more likely to suffer from system failures than were white women or those with Medicare or commercial insurance.

The authors attribute these breakdowns to poor interactions between surgeons and medical oncologists, and between physicians and patients. Suggestions to improve coordination include a referral system that feeds results back to surgeons; patient assistant providers to help facilitate conversations, coach patients, and navigate the health care system; and Medicaid reimbursement policies that reward coordinated care.