CHAMBER: A Regional Performance Improvement CME Initiative for Breast Cancer Health Care Providers

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Linda M. Sutton From Department of Medicine, Duke School of Medicine and Health System, and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee; The France Foundation, Old Lyme, Connecticut; Duke Medicine, Center For Educational Excellence, Duke Clinical Research Institute, and Duke School of Medicine, Center for Educational Excellence, Durham, North Carolina; and American Anesthesiology, Mednax National Medical Group, Sunrise, Florida.

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Joseph Geradts From Department of Medicine, Duke School of Medicine and Health System, and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee; The France Foundation, Old Lyme, Connecticut; Duke Medicine, Center For Educational Excellence, Duke Clinical Research Institute, and Duke School of Medicine, Center for Educational Excellence, Durham, North Carolina; and American Anesthesiology, Mednax National Medical Group, Sunrise, Florida.

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Erika P. Hamilton From Department of Medicine, Duke School of Medicine and Health System, and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee; The France Foundation, Old Lyme, Connecticut; Duke Medicine, Center For Educational Excellence, Duke Clinical Research Institute, and Duke School of Medicine, Center for Educational Excellence, Durham, North Carolina; and American Anesthesiology, Mednax National Medical Group, Sunrise, Florida.

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Kathleen A. Havlin From Department of Medicine, Duke School of Medicine and Health System, and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee; The France Foundation, Old Lyme, Connecticut; Duke Medicine, Center For Educational Excellence, Duke Clinical Research Institute, and Duke School of Medicine, Center for Educational Excellence, Durham, North Carolina; and American Anesthesiology, Mednax National Medical Group, Sunrise, Florida.

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Gretchen G. Kimmick From Department of Medicine, Duke School of Medicine and Health System, and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee; The France Foundation, Old Lyme, Connecticut; Duke Medicine, Center For Educational Excellence, Duke Clinical Research Institute, and Duke School of Medicine, Center for Educational Excellence, Durham, North Carolina; and American Anesthesiology, Mednax National Medical Group, Sunrise, Florida.

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P. Kelly Marcom From Department of Medicine, Duke School of Medicine and Health System, and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee; The France Foundation, Old Lyme, Connecticut; Duke Medicine, Center For Educational Excellence, Duke Clinical Research Institute, and Duke School of Medicine, Center for Educational Excellence, Durham, North Carolina; and American Anesthesiology, Mednax National Medical Group, Sunrise, Florida.

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Neil L. Spector From Department of Medicine, Duke School of Medicine and Health System, and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee; The France Foundation, Old Lyme, Connecticut; Duke Medicine, Center For Educational Excellence, Duke Clinical Research Institute, and Duke School of Medicine, Center for Educational Excellence, Durham, North Carolina; and American Anesthesiology, Mednax National Medical Group, Sunrise, Florida.

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Melanie Watson From Department of Medicine, Duke School of Medicine and Health System, and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee; The France Foundation, Old Lyme, Connecticut; Duke Medicine, Center For Educational Excellence, Duke Clinical Research Institute, and Duke School of Medicine, Center for Educational Excellence, Durham, North Carolina; and American Anesthesiology, Mednax National Medical Group, Sunrise, Florida.

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Daniel U. Rabin From Department of Medicine, Duke School of Medicine and Health System, and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee; The France Foundation, Old Lyme, Connecticut; Duke Medicine, Center For Educational Excellence, Duke Clinical Research Institute, and Duke School of Medicine, Center for Educational Excellence, Durham, North Carolina; and American Anesthesiology, Mednax National Medical Group, Sunrise, Florida.

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Theodore O. Bruno From Department of Medicine, Duke School of Medicine and Health System, and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee; The France Foundation, Old Lyme, Connecticut; Duke Medicine, Center For Educational Excellence, Duke Clinical Research Institute, and Duke School of Medicine, Center for Educational Excellence, Durham, North Carolina; and American Anesthesiology, Mednax National Medical Group, Sunrise, Florida.

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Amanda Noe From Department of Medicine, Duke School of Medicine and Health System, and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee; The France Foundation, Old Lyme, Connecticut; Duke Medicine, Center For Educational Excellence, Duke Clinical Research Institute, and Duke School of Medicine, Center for Educational Excellence, Durham, North Carolina; and American Anesthesiology, Mednax National Medical Group, Sunrise, Florida.

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Stacy Miller From Department of Medicine, Duke School of Medicine and Health System, and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee; The France Foundation, Old Lyme, Connecticut; Duke Medicine, Center For Educational Excellence, Duke Clinical Research Institute, and Duke School of Medicine, Center for Educational Excellence, Durham, North Carolina; and American Anesthesiology, Mednax National Medical Group, Sunrise, Florida.

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Chitra Subramaniam From Department of Medicine, Duke School of Medicine and Health System, and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee; The France Foundation, Old Lyme, Connecticut; Duke Medicine, Center For Educational Excellence, Duke Clinical Research Institute, and Duke School of Medicine, Center for Educational Excellence, Durham, North Carolina; and American Anesthesiology, Mednax National Medical Group, Sunrise, Florida.

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Sherry Layton From Department of Medicine, Duke School of Medicine and Health System, and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee; The France Foundation, Old Lyme, Connecticut; Duke Medicine, Center For Educational Excellence, Duke Clinical Research Institute, and Duke School of Medicine, Center for Educational Excellence, Durham, North Carolina; and American Anesthesiology, Mednax National Medical Group, Sunrise, Florida.

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Katherine Grichnik From Department of Medicine, Duke School of Medicine and Health System, and Department of Pathology, Duke University Medical Center, Durham, North Carolina; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee; The France Foundation, Old Lyme, Connecticut; Duke Medicine, Center For Educational Excellence, Duke Clinical Research Institute, and Duke School of Medicine, Center for Educational Excellence, Durham, North Carolina; and American Anesthesiology, Mednax National Medical Group, Sunrise, Florida.

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CHAMBER was a regional educational initiative for providers of care to patients with HER2+ breast cancer. The study goals were to (1) enhance testing for HER2/neu overexpression in patients with invasive breast cancer; (2) increase the appropriate use of targeted therapy for patients with HER2+ breast cancer; and (3) enhance patients' coping ability. This Performance Improvement Continuing Medical Education (PI-CME) initiative included clinical practice assessment, educational activities, and reassessment. Chart review revealed a high rate of HER2 testing (98%) before and after education. Targeted therapy for patients with HER2+ breast cancer declined after the program (from 96% to 61%), perhaps attributable to an increase in awareness of medical reasons to avoid use of targeted therapy. Assessment for patients' emotional coping ability increased after education (from 55% to 76%; P=.01). Rates of testing for HER2 amplification and assessment of emotional well-being after education were consistent with ASCO Quality Oncology Practice Initiative benchmark values. Documentation of actions to address emotional problems remained an area for improvement.

Correspondence: Daniel U. Rabin, PhD, The France Foundation, 10 Vista Drive, Suite 100, Old Lyme, CT 06371. E-mail: drabin@francefoundation.com
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