A team of researchers from the University of Pittsburgh and UPMC Hillman Cancer Center has developed an innovative prompt integrated into the electronic health record system. The prompt serves as a reminder for treating surgeons to identify older patients with early-stage breast cancer who may be at risk for undergoing unnecessary lymph node surgery.
In a recent publication in JAMA Surgery, the research team reported a significant decrease in the rate of a surgical procedure known as sentinel lymph node biopsy (SLNB) among eligible patients after the implementation of this prompt. This reduction suggests that a simple electronic reminder could help prevent overtreatment of older breast cancer patients.
Dr. Priscilla McAuliffe, senior author of the study and breast surgical oncologist at UPMC Hillman and UPMC Magee-Womens Hospital, highlighted the importance of personalized care in breast cancer treatment. She explained, “SLNB is a valuable tool to assess cancer spread to the lymph nodes, but it may not be necessary for every patient. The user-friendly prompt prompts surgeons to carefully consider the necessity of SLNB for each individual.”
The American Board of Internal Medicine Choosing Wisely recommendation, supported by the Society of Surgical Oncology, advises against routine SLNB for patients aged 70 and above with early-stage estrogen-receptor positive breast cancer due to the low risk of metastasis. Despite this recommendation, many women in this age group still undergo the procedure despite its limited impact on treatment decisions and potential side effects.
Neil Carleton, the first author of the study and a student in Pitt’s Medical Scientist Training Program, emphasized the risks associated with SLNB, such as lymphedema, a common complication that can significantly affect a patient’s quality of life. Given the challenges older patients face during surgery and recovery, the research team aimed to avoid unnecessary SLNB procedures.
The team, comprising Dr. McAuliffe, Carleton, and other experts, developed an electronic health record prompt to remind surgeons to evaluate the appropriateness of SLNB for eligible patients based on their age and tumor characteristics. To evaluate the prompt’s effectiveness, a non-randomized clinical trial involving seven surgeons from surgical oncology clinics was conducted.
Results showed a 49.3% reduction in SLNB procedures among eligible patients during the 12-month intervention period, which further dropped to 15.6% during a subsequent 6-month follow-up. Surgeons positively reviewed the prompt, noting its ease of integration into their workflow without additional paperwork.
Furthermore, by employing artificial intelligence technology from Realyze Intelligence, the researchers analyzed patient records for lymphedema symptoms and observed a decrease in symptomatic cases following the prompt implementation.
The research team intends to expand the use of the prompt to UPMC physicians beyond the breast surgical team, aiming to enhance care delivery to a broader patient population, including those in community healthcare settings.
This study aligns with the team’s broader objective of tailoring breast cancer treatment to individual patients and minimizing unnecessary treatments. Previous research by the team, published in JCO Clinical Cancer Informatics, suggests extending the recommendation against routine SLNB to post-menopausal women over 55.
In addition to its application in this study, Realyze Intelligence’s AI technology is successfully utilized at UPMC Hillman Cancer Center to match patients with relevant clinical trials.
Other authors of the study include researchers from Pitt, UPMC, and Realyze Intelligence, with support from the NIH, UPMC Hillman Cancer Center, and UPMC eRecord Ambulatory Decision Support and Analytics.
