Explaining variation in quality of breast cancer care and its impact: a nationwide population-based study from Slovenia

Plavc, Gaber; Ratoša, Ivica; Žagar, Tina; Zadnik, Vesna

doi:10.1007/s10549-019-05186-z

Cited by 11 publications

(33 citation statements)

References 28 publications

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“…Several studies were conducted before 2003, when guidelines and treatments differed than those currently in use. Out of all recent studies [9–29], the only few conducted at the population level [9–12,16,17,28,29] used recent data (after 2010) [28,29]. Five studies using EUSOMA QIs [22,24–27] were hospital-based and included patients from voluntary centers (often EUSOMA certified centers [22,24–26]), which may introduce selection biases and overestimate compliance.…”

Section: Discussionmentioning

confidence: 99%

“…The assessment of health system performance in BC care requires measuring of compliance in “real-life” situations. In 2019, two population-based studies on EUSOMA QIs for the management of BC diagnosed in 2013 and 2016 were conducted in Slovenia and Norway [28,29]. The results of these studies are difficult to generalize to French patients because of differences between health systems.…”

Section: Discussionmentioning

confidence: 99%

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Compliance with clinical guidelines for breast cancer management: A population-based study of quality-of-care indicators in France

Cowppli-Bony

Trétarre²,

Marrer³

et al. 2019

PLoS ONE

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BackgroundThe European Society of Breast Cancer Specialists (EUSOMA), which aims to standardize the quality of patient care in Europe, has defined quality indicators (QIs) for breast cancer (BC) care to assess compliance to current care standards. These QIs are a useful tool to evaluate care organizations. Only population-based studies are able to assess health system performance in “real-life” situations. This population-based study aimed to describe compliance with several EUSOMA QIs overall and according to patient and organizational factors in France.Methods1 560 adult women with primary invasive non-metastatic BC diagnosed in 2012 were randomly selected among all incident BC from 16 French geographical areas covered by cancer registries. Twelve EUSOMA QIs were selected regarding diagnosis, treatment and staging.ResultsThe minimum standard as proposed by EUSOMA was met for nine QIs related to pre-operative definitive diagnosis, multidisciplinary discussion and treatment (single surgery, breast conserving surgery (BCS) for small BC (<3cm), radiotherapy after BCS or mastectomy for regional BC (pN≥2a), hormonotherapy, adjuvant chemotherapy and trastuzumab). Low compliance was observed for sentinel lymph node biopsy (SLNB) and staging imaging. Adherence to guidelines was usually lower in older patients and in patients with comorbidities. Multidisciplinary discussion was positively related to adherence to guidelines for diagnosis, staging practices (SNLB, imaging) and systemic treatments. Compliance also varied by area of residence and by place of first treatment.ConclusionThis study provides the first current, comprehensive overview of BC quality care at a population level in France. The guidelines were correctly applied in percentage satisfying the EUSOMA standards for the diagnosis and treatment of BC, although staging practices (SLNB, imaging) can be improved. These results highlight the need for continuous measurement of adherence to guidelines to improve BC care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Compliance with clinical guidelines for breast cancer management: A population-based study of quality-of-care indicators in France

Cowppli-Bony

Trétarre²,

Marrer³

et al. 2019

PLoS ONE

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“…The proportion of patients who received intensive follow-up in the 12 months following discharge after MBC surgery reached 18.2% in 2016, it is a high proportion considering that EUSOMA reported the absence of survival benefit from intensive screening for secondary prevention in patients with asymptomatic metastatic diseases. The medical therapy and radiotherapy indicators, in 2016 and 2015 respectively, reached low values compared with the EUSOMA standards [5] and most of the international studies which have assessed the use of adjuvant therapy after MBC surgeries [29][30][31][32][33][34].…”

Section: Plos Onementioning

confidence: 94%

Evaluation of the breast cancer care network within the Lazio Region (Central Italy)

Ferranti¹,

Pinnarelli²,

Rosa³

et al. 2020

PLoS ONE

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Background and objectives A summary indicator for evaluating the breast cancer network has never been measured at the regional level. The aim is to design treemaps providing a summary description of hospitals (including breast units) and Local Health Units (LHUs) in terms of their levels of performance within the breast cancer network of the Lazio region (central Italy). The treemap structure has an intuitive design and displays information from both general and specific analyses. Methods Patients admitted to the regional hospitals for malignant breast cancer (MBC) surgery in 2010-2017 were selected in a population-based cohort study. These quality indicators were calculated based on the international guidelines (EUSOMA, ESMO) to assess the performance in terms of volume of activity, surgery procedure, post-surgery assistance and timeliness of medical therapy or radiotherapy beginning. The quality indicators were calculated using administrative health data systematically collected at the regional level and were included in the treemap to represent the surgery or the post-surgery areas of the breast cancer clinical pathway. In order to allow aggregation of scores for different indicators belonging to the same clinical area, up to five evaluation classes were defined using the "Jenks Natural Breaks" algorithm. A score and a colour were assigned to each clinical area based on the ranking of the indicators involved. The analyses were performed on an annual basis, by the LHU of residence and by the hospital which performed the surgical intervention. Results In 2017, 6218 surgical interventions for MBC were performed in the hospitals of Lazio. The results showed a continuous increase of the level of performance over the years. Hospitals showed higher variability in the levels of performance than the LHUs. 36% of the evaluated hospitals reached a high level of performance. An audit of the S. Filippo Neri breast unit

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“…[ 1 ], assessing compliance of breast cancer (BC) care with EUSOMA [ 2 ] quality indicators (QIs). As more and more studies evaluating the quality of BC care are using EUSOMA-QIs, we think it is important to clarify inconsistencies in their definitions which might have influenced the results of this study and similar ones [ 1 , [3] , [4] , [5] ].…”

mentioning

confidence: 99%

“…Firstly, there is a discrepancy in the definition of hormone-positive (HR+) BC. Recent studies considered HR+ BC if immunostaining was seen in ≥1% tumor nuclei [ 4 , 5 ] compared to Pons-Tostivint et al. [ 1 ] using a cut-off value of ≥10%, which calls for unified definition of HR+ disease in EUSOMA-QIs to homogenise reporting.…”

mentioning

confidence: 99%

Comment on: “Multidisciplinary team meeting and EUSOMA quality indicators in breast cancer care: A French regional multicenter study”

Ratoša

Plavc

2020

The Breast

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Explaining variation in quality of breast cancer care and its impact: a nationwide population-based study from Slovenia

Cited by 11 publications

References 28 publications

Compliance with clinical guidelines for breast cancer management: A population-based study of quality-of-care indicators in France

Compliance with clinical guidelines for breast cancer management: A population-based study of quality-of-care indicators in France

Evaluation of the breast cancer care network within the Lazio Region (Central Italy)

Comment on: “Multidisciplinary team meeting and EUSOMA quality indicators in breast cancer care: A French regional multicenter study”

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