Breast Cancer: global quality care optimizing care delivery with existing financial and personnel resources

Verhoeven, Didier; Allemani, Claudia; Kaufman, Cary S.; Mansel, Robert Edward; Siesling, Sabine; Anderson, Brent

doi:10.1136/esmoopen-2020-000861

Cited by 12 publications

(10 citation statements)

References 22 publications

(23 reference statements)

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“…This study adds to a growing body of literature that characterizes the surgical and systemic treatment care continuum for patients treated in cancer programs in LICs. These efforts are leading to the emergence of context-specific quality metrics to guide meaningful quality improvement efforts [ 37 – 39 ]. Ongoing efforts at HUM are focused on identifying and supporting vulnerable patients, as well as systematically tracking where patients are in the care pathway to ensure retention in care and receipt of timely care.…”

Section: Discussionmentioning

confidence: 99%

Gaps in completion and timeliness of breast surgery and adjuvant therapy: a retrospective cohort of Haitian patients with nonmetastatic breast cancer

Fadelu

Erfani

Lormil³

et al. 2022

Breast Cancer Res Treat

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Background There are limited data on breast surgery completion rates and prevalence of care-continuum delays in breast cancer treatment programs in low-income countries. Methods This study analyzes treatment data in a retrospective cohort of 312 female patients with non-metastatic breast cancer in Haiti. Descriptive statistics were used to summarize patient characteristics; treatments received; and treatment delays of > 12 weeks. Multivariate logistic regressions were performed to identify factors associated with receiving surgery and with treatment delays. Exploratory multivariate survival analysis examined the association between surgery delays and disease-free survival (DFS). Results Of 312 patients, 249 (80%) completed breast surgery. The odds ratio (OR) for surgery completion for urban vs. rural dwellers was 2.15 (95% confidence interval [CI]: 1.19–3.88) and for those with locally advanced vs. early-stage disease was 0.34 (95%CI: 0.16–0.73). Among the 223 patients with evaluable surgery completion timelines, 96 (43%) experienced delays. Of the 221 patients eligible for adjuvant chemotherapy, 141 (64%) received adjuvant chemotherapy, 66 of whom (47%) experienced delays in chemotherapy initiation. Presentation in the later years of the cohort (2015–2016) was associated with lower rates of surgery completion (75% vs. 85%) and with delays in adjuvant chemotherapy initiation (OR [95%CI]: 3.25 [1.50–7.06]). Exploratory analysis revealed no association between surgical delays and DFS. Conclusion While majority of patients obtained curative-intent surgery, nearly half experienced delays in surgery and adjuvant chemotherapy initiation. Although our study was not powered to identify an association between surgical delays and DFS, these delays may negatively impact long-term outcomes.

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Section: Discussionmentioning

confidence: 99%

Gaps in completion and timeliness of breast surgery and adjuvant therapy: a retrospective cohort of Haitian patients with nonmetastatic breast cancer

Fadelu

Erfani

Lormil³

et al. 2022

Breast Cancer Res Treat

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“…Based on previous reports on QIs for systemic treatment of BC, we identified 12 process (sub)indicators, with the aim to reveal sensitive aspects of actual (mis)use of resources. 12 , 21 Financial implications, adherence to guidelines, and quality of life were the common threads in the selection process. In general, the overall national results appear within acceptable bounds, but some indicators disclose a substantial variability between centres.…”

Section: Discussionmentioning

confidence: 99%

Assessment of potential process quality indicators for systemic treatment of breast cancer in Belgium: a population-based study

Walle¹,

Punie

Eycken³

et al. 2021

ESMO Open

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Background: Quality indicators (QIs) for the management of breast cancer (BC) have been published in Europe and internationally. In Belgium, a task force was established to select measurable process indicators of systemic treatment for BC, focusing on appropriateness of delivered care. The objective of this study was to evaluate the results of the selected QIs, both nationally and among individual centres. Patients and Methods: Female Belgian residents with unilateral primary invasive BC diagnosed between 2010 and 2014 were selected from the Belgian Cancer Registry database. The national number enabled linkage with the national reimbursement database, which contains information on all reimbursed medical procedures. A total of 12 process indicators were measured on the population and hospital level. Intercentre variability was assessed by median results and interquartile ranges. Results: A total of 48 872 patients were included in the study. QIs concerning specific BC subtypes only applied to patients diagnosed in 2014 (n ¼ 9855). Clinical stage (cStage) I patients (n ¼ 17 116) were staged with positron emission tomography/computed tomography. Among patients who were pT1aN0 human epidermal growth factor receptor 2 (HER2) positive (n ¼ 47), 25.5% (n ¼ 12) received adjuvant trastuzumab. Among patients with de novo metastatic luminal A/B-like HER2-negative BC (n ¼ 295), 17.3% (n ¼ 51) received upfront chemotherapy. (Neo) adjuvant chemotherapy was administered in 52.4% (n ¼ 12 592) of operated women with cStage I-III, in 37.0% (n ¼ 1270) of operated women with cStage I-III luminal A/B-like HER2-negative BC, and in 19.1% of operated women with cStage I luminal A/B-like HER2-negative BC. In the population of operated patients with cStage I-III, of those younger than 70 years that started adjuvant endocrine therapy (n ¼ 3591), 81.7% (n ¼ 2932) continued treatment for !4.5 years. Among patients in cStage I-III older than 70 years (n ¼ 8544), 19.0% (n ¼ 1622) received (neo) adjuvant chemotherapy, whereas among patients with cStage I-III luminal A/B-like HER2-negative BC (n ¼ 1388), 13.0% (n ¼ 181) received (neo)adjuvant chemotherapy. In patients with cStage I-II luminal A/B-like HER2-negative BC older than 70 years (n ¼ 1477), 11.6% (n ¼ 171) were not operated and received upfront endocrine treatment. Conclusion: Well-considered QIs using population-based data can evaluate quality of care and expose disparities among treatment centres. Their use in daily practice should be implemented in all centres treating BC.

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“…In early 2020, the book "Breast Cancer: Global Quality Care" was published by Oxford University Press (1) (Figure 1). In August 2020, the article "Breast Cancer: Global Quality Care, Optimizing Care Delivery with Existing Financial and Personnel Resources" was published in ESMO-Open (2). On November 16 th , 2020, during the 4 th International Oncology Leadership Conference by the Mandrier Group, a virtual meeting was organized, involving key faculty members.…”

Section: Introduction (Video 1)mentioning

confidence: 99%

New Frontiers for Fairer Breast Cancer Care in a Globalized World

Verhoeven

Allemani

Kaufman

et al. 2021

EJBH

Self Cite

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In early 2020, the book "Breast cancer: Global Quality Care" was published by Oxford University Press. In the year since then, publications, interviews (by ecancer), presentations, webinars, and virtual congress have been organized to disseminate further the main message of the project: "A call for Fairer Breast Cancer Care for all Women in a Globalized World." Special attention is paid to increasing the "value-based healthcare" putting the patient in the center of the care pathway and sharing information on high-quality integrated breast cancer care. Specific recommendations are made considering the local resource facilities. The multidisciplinary breast conference is considered "the jewel in the crown" of the integrated practice unit, connecting multiple specializations and functions concerned with patients with breast cancer. Management and coordination of medical expertise, facilities, and their interfaces are highly recommended. The participation of two world-leading cancer research programs, the CONCORD program and Breast Health Global Initiative, in this project has been particularly important. The project is continuously under review with feedback from the faculty. The future plan is to arrive at an openaccess publication that is freely available to all interested people. This project is designed to help ease the burden and suffering of women with breast cancer across the globe.

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Breast Cancer: global quality care optimizing care delivery with existing financial and personnel resources

Cited by 12 publications

References 22 publications

Gaps in completion and timeliness of breast surgery and adjuvant therapy: a retrospective cohort of Haitian patients with nonmetastatic breast cancer

Gaps in completion and timeliness of breast surgery and adjuvant therapy: a retrospective cohort of Haitian patients with nonmetastatic breast cancer

Assessment of potential process quality indicators for systemic treatment of breast cancer in Belgium: a population-based study

New Frontiers for Fairer Breast Cancer Care in a Globalized World

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