Quality indicators in breast cancer care: An update from the EUSOMA working group

Biganzoli, Laura; Marotti, Lorenza; Hart, Christopher; Cataliotti, Luigi; Cutuli, B.; Kühn, Thorsten; Mansel, Robert Edward; Ponti, Antonio; Poortmans, Philip; Regitnig, Peter; Hage, Jos A. van der; Wengström, Yvonne; Turco, Marco Rosselli Del

doi:10.1016/j.ejca.2017.08.017

Cited by 178 publications

(259 citation statements)

References 171 publications

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“…Breast reconstruction (BR) has long been recognized as a means of supporting recovery from the psychological and emotional trauma of mastectomy, enhancing body image and improving quality of life . Many guidelines globally now recommended BR for all women undergoing mastectomy as part of their breast cancer treatment …”

Section: Introductionmentioning

confidence: 99%

Patterns of immediate breast reconstruction in New South Wales, Australia: a population‐based study

Feng

Flitcroft

Leeuwen

et al. 2019

ANZ Journal of Surgery

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BackgroundThe rate of immediate breast reconstruction (IBR) following mastectomy for breast cancer in Australia is low and varies between regions. To date, no previous Australian studies have examined IBR rates between all hospitals within a particular jurisdiction, despite hospitals being an important known contributor to variation in IBR rates in other countries.MethodsWe used cross‐classified random‐effects logistic regression models to examine the inter‐hospital variation in IBR rates by using data on 7961 women who underwent therapeutic mastectomy procedures in New South Wales (NSW) between January 2012 and June 2015. We derived IBR rates by patient‐, residential neighbourhood‐ and hospital‐related factors and investigated the underlying drivers for the variation in IBR.ResultsWe estimated the mean IBR rate across all hospitals performing mastectomy to be 17.1% (95% Bayesian credible interval (CrI) 12.1–23.1%) and observed wide inter‐hospital variation in IBR (variance 4.337, CrI 2.634–6.889). Older women, those born in Asian countries (odds ratio (OR) 0.5, CrI 0.4–0.6), residing in neighbourhoods with lower socioeconomic status (OR 0.7, CrI 0.5–0.8 for the most disadvantaged), and who underwent surgery in public hospitals (OR 0.4, CrI 0.1–1.0) were significantly less likely to have IBR. Women residing in non‐metropolitan areas and attending non‐metropolitan hospitals were significantly less likely to undergo IBR than their metropolitan counterparts attending metropolitan hospitals.ConclusionWide inter‐hospital variation raises concerns about potential inequities in access to IBR services and unmet demand in certain areas of NSW. Explaining the underlying drivers for IBR variation is the first step in identifying policy solutions to redress the issue.

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Section: Introductionmentioning

confidence: 99%

Patterns of immediate breast reconstruction in New South Wales, Australia: a population‐based study

Feng

Flitcroft

Leeuwen

et al. 2019

ANZ Journal of Surgery

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“…The principal aim of our study was to investigate the effect of comorbidities at diagnosis (as assessed by the Charlson comorbidity index [CCI]), also considering age and tumour subtype, on differences in adherence to selected components of standard treatment, for European women diagnosed with early stage BC in 2009–2013. The standard treatments considered were the proportions of women who received: (a) surgery; (b) breast‐conserving surgery followed by radiotherapy (BCS + RT); (c) reconstruction after mastectomy; and (d) prompt treatment (≤6 weeks of diagnosis) . Surgery has long been essential for the curative treatment of early BC .…”

Section: Introductionmentioning

confidence: 99%

Comorbidities, age and period of diagnosis influence treatment and outcomes in early breast cancer

Minicozzi

Eycken²,

Molinié

et al. 2018

Intl Journal of Cancer

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Survival for breast cancer (BC) is lower in eastern than northern/central Europe, and in older than younger women. We analysed how comorbidities at diagnosis affected whether selected standard treatments (STs) were given, across Europe and over time, also assessing consequences for survival/relapse. We analysed 7581 stage I/IIA cases diagnosed in 9 European countries in 2009-2013, and 4 STs: surgery; breast-conserving surgery plus radiotherapy (BCS + RT); reconstruction after mastectomy; and prompt treatment (≤6 weeks after diagnosis). Covariate-adjusted models estimated odds of receiving STs and risks of death/relapse, according to comorbidities. Pearson's R assessed correlations between odds and risks. The z-test assessed the significance of time-trends. Most women received surgery: 72% BCS; 24% mastectomy. Mastectomied patients were older with more comorbidities than BCS patients (p < 0.001). Women given breast reconstruction (25% of mastectomies) were younger with fewer comorbidities than those without reconstruction (p < 0.001). Women treated promptly (45%) were younger than those treated later (p = 0.001), and more often without comorbidities (p < 0.001). Receiving surgery/BCS + RT correlated strongly (R = −0.9), but prompt treatment weakly (R = −0.01/−0.02), with reduced death/relapse risks. The proportion receiving BCS + RT increased significantly (p < 0.001) with time in most countries. This appears to be the first analysis of the influence of comorbidities on receiving STs, and of consequences for outcomes. Increase in BCS + RT with time is encouraging. Although women without comorbidities usually received STs, elderly patients often received non-standard less prompt treatments, irrespective of comorbidities, with increased risk of mortality/relapse. All women, particularly the elderly, should receive ST wherever possible to maximise the benefits of modern evidence-based treatments.

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“…Moreover, the morbidity rate of SLN biopsy and its negative impact on the quality of life of approximately 23% of patients should be included into a cost/benefit ratio, which should also consider the risk to postpone the adjuvant treatment due to SLN-related morbidity (11). Actually, avoiding SLN biopsy represents a good quality indicator of best practice in breast cancer treatment established by EUSOMA (12). Moreover, even from a prognostic standpoint, SLN biopsy was not specifically predictive concerning the need of adjuvant medical treatment because patients with a positive SLN would have undergone adjuvant therapy based, per se, on the biologic prognostic factors of the primary tumor.…”

Section: Discussionmentioning

confidence: 99%

“…According to current guidelines, SLN biopsy should not be performed in patients with carcinoma in situ of the breast undergoing conservative treatment but only in patients with a definitive diagnosis of invasive carcinoma or in patients with carcinoma in situ undergoing total mastectomy (1,3,5,(6)(7)(8)(9)(10)(11)(12). Here, we performed a retrospective study in patients undergoing breast-conserving surgery with a preoperative diagnosis of B5c was undertaken in order to assess the usefulness of axillary node staging by means of SLN biopsy.…”

mentioning

confidence: 99%

The Role of Sentinel Lymph Node Biopsy in Patients With B5c Breast Cancer Diagnosis

Fregatti

Gipponi

Díaz

et al. 2019

In Vivo

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Background/Aim: The histopathological assessment of the B5c category may sometimes be hampered by simple artifacts that may lead to over-or underestimation of that particular breast cancer so that its management is still controversial, especially with regard to the decision to proceed immediately to sentinel lymph node (SLN) biopsy. Hence, a retrospective study was performed in 174 patients undergoing breast-conserving surgery with a preoperative diagnosis of B5c in order to assess the usefulness of axillary node staging by means of SLN biopsy. Patients and Methods: Pre-and postoperative parameters including imaging data, histology of the primary tumor and SLN biopsy, biological prognostic factors, type of operation, and adjuvant regimens were computed. Results: Invasive carcinoma and carcinoma in situ were diagnosed in 46 (26.5%) and 128 patients (73.5%), respectively. Preoperative tumor size was significantly related to postoperative diagnosis of invasive carcinoma (p=0.020), retaining its predictive value at logistic regression analysis (p=0.046). Post-operative predictive factors of invasion were represented by tumor stage (p=0.008) and grading (p=0.008). Conclusion: B5c preoperative diagnosis in patients undergoing breast conservative surgery would suggest an immediate wide local excision avoiding any further preoperative histologic assessment. Conversely, one-stage SLN biopsy might be suggested for patients eligible to mastectomy, similar to patients with carcinoma in situ, although its impact on the therapeutic and prognostic assessment seems negligible. 355

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Quality indicators in breast cancer care: An update from the EUSOMA working group

Cited by 178 publications

References 171 publications

Patterns of immediate breast reconstruction in New South Wales, Australia: a population‐based study

Patterns of immediate breast reconstruction in New South Wales, Australia: a population‐based study

Comorbidities, age and period of diagnosis influence treatment and outcomes in early breast cancer

The Role of Sentinel Lymph Node Biopsy in Patients With B5c Breast Cancer Diagnosis

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