Past Medical query - stage 3 breast cancer

dallend@einstein.edu

HI

My facility currently has a consulting group reviewing charts - they recommended a query for the following clinical scenario:

Pt admitted with CAP (2 day LOS).

Pt is currently being treated (at another facility) for stage 3 breast cancer - chemo and radiation. Her oncologist is not a physician at this  facility. Her surgery was at the same facility where she is being treated. There are no notes from outside providers in the chart - the patient was only seen by our hospitalist team.

The consultant group is requesting a query for lymph node mets since she is stage 3 breast cancer.  We have nothing to use as a basis for a query other than the fact that she has stage 3 breast cancer. I am aware that stage 3 cancer could involve the lymph nodes.

Has anyone ever had to deal with this?  I must say in my 16 years in CDI this is a new one for me.

lprescott1

It is my understanding that stage 3 breast cancer identifies that the cancer has spread beyond the initial tumor and may include the near by lymph nodes. The capture of spread to the lymph nodes does assist in adding to the risk score, especially if they can identify the specific chain, which is likely why they wish you to query. the difficult piece is your provider may not have the complete history to provide that information.  I would perhaps query to identify if they know where the tumor has spread to. You likely have no other clinical indicators but the identification of stage 3- unless you have any imaging with incidental findings as I am assuming the patient is seeing you for a reason other than the cancer.

dallend@einstein.edu

Yes, the patient was not admitted for anything related to the breast cancer and oncology was not consulted during the stay.  All we have to go on is "Stage 3 Breast cancer". There are no imaging results in the patient's medical record.

Thanks for your help.