Breast cancer management and outcome according to surgeon's affiliation: a population-based comparison adjusted for patient's selection bias

Taban, F.; Rapiti, Elisabetta; Fioretta, G; Wespi, Y.; ffytche, Dominic H.; Hügli, Anne; Schubert, Hyma; Vlastos, Georges; Castiglione, M.

doi:10.1093/annonc/mds285

Cited by 3 publications

(4 citation statements)

References 18 publications

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“…Although there were differences in the proportion of "unknown data" for some variables, tumour characteristics did not differ significantly across the surgeon groups (table 2). In comparison with previously published data from the public sector [35] patients tended to be younger, from higher socio-economic status and more often born in Switzerland. The tumour characteristics, however, were similar (tables 1 and 2).…”

Section: Patient and Tumour Characteristicscontrasting

confidence: 71%

“…Also, this study focuses on breast cancer patients treated in the private sector; no extrapolation of our results to the public sector can be made, and we were unable to reproduce similar analyses for the public sector since the identity of the surgeons in university hospitals is unclear. However, indirect comparison with a public breast cancer unit during a similar time period showed comparable quality of care [35]. We did not control for the potential impact of "hospital volume", but we are quite confident that, since there are only three private hospitals in Geneva, which are very similar in size, in their recruitment of breast cancer patients and in the quality of care they provide, this should not influence our re- sults.…”

Section: Strengths and Limitationsmentioning

confidence: 87%

“…For each patient, we calculated the proportion of pertinent indicators correctly fulfilled, as explained in detail in a previous study [35]. This overall quality-of-care score was categorised as <75%, 75-90% or 90-100% of the items fulfilled.…”

Section: Indicators Of Quality Of Carementioning

confidence: 99%

“…In order to allow indirect comparison with the public sector, we additionally present the data reported in a previously published study on a similar cohort from a public breast cancer unit [35].…”

Section: Indicators Of Quality Of Carementioning

confidence: 99%

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Impact of experience in breast cancer surgery on survival: the role of quality of care in a registry-based cohort

Taban¹,

Elia

Rapiti

et al. 2019

Swiss Med Wkly

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AIMS OF THE STUDY: Previous studies have suggested that the surgeon's experience in breast cancer surgery may affect patient survival. In this registry-based retrospective cohort study, we examined whether quality of care could partly explain this association. METHODS: All invasive breast cancers operated on in the private sector between 2000 and 2009 were identified in the Geneva Cancer Registry and followed up for 5 years. Surgeons were classified according to their experience into three categories: ≤5, 6-10, >10 breast cancer operations performed per year. We extracted patient and tumour characteristics. Quality of care was scored as the proportion of 11 quality indicators correctly fulfilled for each patient. Breast cancer-specific mortality was examined with a Cox model adjusted for variables known to affect survival, surgeon experience, and quality of care. RESULTS: A total of 1489 patients were operated on by 88 surgeons; 50 patients (3.4%) died from breast cancer during the 5 years of follow-up. Socioeconomic status and country of birth of the patients, as well as period of diagnosis, differed according to the surgeons' experience. Quality of care provided improved with surgeon's experience. Surgeons performing >10 operations/year more frequently assessed histology before surgery, excised sentinel lymph nodes, removed ≥10 lymph nodes, and prescribed adjuvant radiotherapy when indicated. Crude breast cancerspecific mortality was lower in patients treated by surgeons performing >10 compared with ≤5 operations/year (hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.17-0.67; p = 0.002). The strength of the association decreased after adjustment for patient and tumour characteristics (HR 0.45, 95% CI 0.21-0.94; p = 0.034) and decreased further after adjustment for quality of care (HR 0.51, 95% CI 0.24-1.08, p = 0.078). CONCLUSIONS:The association between surgeon's experience and 5-year breast cancer survival is at least part-ly explained by quality of care, patient and tumour characteristics. Further investigations on the impact of other quality indicators such as multidisciplinary networks are needed.

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Section: Patient and Tumour Characteristicscontrasting

confidence: 71%

Section: Strengths and Limitationsmentioning

confidence: 87%

Section: Indicators Of Quality Of Carementioning

confidence: 99%

Section: Indicators Of Quality Of Carementioning

confidence: 99%

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