Factors Influencing the Quality of Local Management of Ductal Carcinoma In Situ: A Cohort Study

Krotneva, Stanimira; Reidel, Kristen; Verma, Aman; Mayo, Nancy E.; Tamblyn, Robyn; Meguerditchian, Ari N.

doi:10.3747/co.20.1293

Cited by 3 publications

(9 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Inter-hospital comparison revealed a large variability among providers (from 65.9 to 90.3%) and low values for the three Tuscan teaching hospitals, surprising professionals themselves. Indeed, the finding of slightly lower proportions of BCS in high-complexity hospitals, which usually have high caseloads, is apparently counterintuitive and in contrast with the literature reporting that higher volumes are positively associated with better practices and outcomes [ 19 ] and in particular with a better chance of receiving a conservative intervention [ 20 – 22 ].…”

Section: Introductionmentioning

confidence: 91%

Catching and monitoring clinical innovation through performance indicators. The case of the breast-conserving surgery indicator

et al. 2017

View full text Add to dashboard Cite

BackgroundThe evolution in the surgical and diagnostic procedures, the attention to women’s preferences, the case mix, and differences in professional practices may lead to a variability in the quality of breast cancer clinical pathway. To catch and manage this variability it is important to use valid measures. The aim of this paper is to examine the concurrent validity of the breast-conserving surgery (BCS) indicator and to provide evidence to guide the quality improvement process.MethodsThe BCS indicator was calculated using hospital discharge records (HDRs) and was validated against surgical registry (SR) data in a random sample of 336 women undergoing breast cancer surgery in 2012 in two Tuscan teaching hospitals. The concurrent validity of BCS was examined by cross-tabulating patients using the ICD-9 CM codes for breast surgery obtained from the two data sources.ResultsThe analysis, carried out involving breast cancer professionals, highlighted that the large majority of interventions coded as “mastectomies” in HDRs are in fact reconstructing procedures, including nipple-sparing, skin-sparing and skin-reducing mastectomies in SR. These results led us to refine the old algorithm, that calculates the proportion of breast-conserving surgery over the total number of breast interventions, and reclassify breast cancer surgical procedures into three categories: conservative, reconstructive and traditional mastectomy. Based on this new classification algorithm, the percentages of (I) reconstructive interventions were 16% at Florence TH and 38.3% at Pisa TH; (II) breast-conserving interventions were respectively 72.8 and 52.1%; and (III) mastectomies 11.2 and 9.6%. After adjusting for age in a logistic regression model, the percentages of reconstructive interventions at Florence and Pisa were respectively 22 and 34% and those of breast-conserving interventions 63 and 53%.ConclusionsOur results indicate that breast cancer care indicators should be refined by distinguishing reconstructive procedures (nipple/skin-sparing surgery with implant or breast tissue expander insertion) from traditional mastectomy. The involvement of breast care professionals in the choice of indicators proved to be crucial to capture the up-to-date breast cancer surgical practice and inform the quality improvement process.

show abstract

Section: Introductionmentioning

confidence: 91%

Catching and monitoring clinical innovation through performance indicators. The case of the breast-conserving surgery indicator

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Women were more likely to be referred to one of the cancer centres if they were younger, have fewer comorbid conditions, and lived closer to a cancer centre. Similarly, in a study of 4139 women with DCIS diagnosed between 1998 and 2005, Krotneva, et al reported that age and distance from a cancer centre influenced the probability of referral [ 17 ]. Our study showed that women referred after surgery were more likely to receive RT after BCS and experienced higher MFS, BCSS, and OS compared to non-referred women, despite having higher risk pathologic features.…”

Section: Discussionmentioning

confidence: 99%

Effect of Referral Patterns and Treatment Type on Oncologic Outcomes for Women with Ductal Carcinoma In Situ

Wai

Lesperance

Lü

et al. 2017

Cureus

View full text Add to dashboard Cite

ObjectiveManagement of ductal carcinoma in situ (DCIS) remains controversial. This study examined long-term outcomes in a population-based cohort of patients with pure DCIS treated with breast-conserving surgery (BCS) alone, BCS + radiotherapy (RT), and mastectomy. Outcomes were compared between patients referred versus not referred for oncologic assessment after definitive surgery.Materials and methodsSubjects were 2575 women diagnosed between 1985 and 1999. Data from several electronic databases were linked and analyzed. Outcomes were invasive local recurrence-free survival (ILRFS), mastectomy-free survival (MFS), breast cancer-specific survival (BCSS), and overall survival (OS).ResultsMedian follow-up time was 9.8 years. Overall, 56% (n = 1448) of subjects were referred to a cancer centre. Factors associated with non-referral were older age, comorbidities, and travel distance. Ten-year MFS, BCSS, and OS were higher among referred patients (all p ≤ 0.001). In cohorts treated with BCS alone (n = 1314) vs. BCS + RT (n = 510) vs. mastectomy (n = 751), 10-year ILRFS were 93.7% vs. 96.6% vs. 97.7%, (p < 0.001) and BCSS were 97.6% vs. 99.8% vs. 98.6%, (p = 0.01). Corresponding rates of ipsilateral invasive breast relapse at 10 years were 6.3% after BCS alone, 3.4% after BCS + RT, and 2.3% after mastectomy (p < 0.001). On multivariable analysis, factors associated with improved ILRFS were older age at diagnosis, low comorbidity score, absence of comedo histology, mastectomy, and post-BCS RT.ConclusionPatients with DCIS referred for oncologic assessment were more likely to undergo post-BCS RT, resulting in lower mastectomy and higher survival rates compared to non-referred patients. Patients with significant comorbidities were less likely to be referred and experienced lower ILRFS and BCSS. Referral for multidisciplinary oncologic assessment after surgery is warranted to individualize management and optimize outcomes for patients with DCIS.

show abstract

“…Thirty studies used GIS to associate geographic measures to patient and/or health system outcomes (Table 4), such as incidence, latency for diagnosis, tumor size at diagnosis, use of primary surgery, RT utilization/interruption, delay in RURs decreased with increasing distances to nearest RT centers. This was demonstrated for palliative RT, 40,51 adjuvant RT for breast cancer, 3,4,34,35,39,45,46,[49][50][51]59,60 rectal cancer, 4,22,40,49,60,61 lung cancer, 4,22,34,40,49,51,60 colon cancer, 47,49 and prostate cancer. 22,49,60 Regional differences were noted in Norway, Australia, the United Kingdom, and the United States.…”

Section: Gis Used To Analyze Health Systems or Patient Outcomesmentioning

confidence: 91%

“…Twenty-four studies used GIS to describe geographic accessibility to RT (Table 3), measured via travel distance 5,[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] and travel time 3,4,20,22,35,36,45,48,[50][51][52][53][54][55] to nearest RT centers. These were calculated on the basis of travel by road, 3,4,20,22,[34][35][36]38,40,[42][43][44][45][46][47][48][49][50][51]…”

Section: Gis Used To Describe Geographic Accessibility To Rtmentioning

confidence: 99%

“…22,49,60 Regional differences were noted in Norway, Australia, the United Kingdom, and the United States. 3,34,40,50,56,62,63 Other covariates such as sex, 22,34,38,40,47,49,51,61 age, 3,22,34,35,[38][39][40]44,46,47,[49][50][51]54,57,60,61 household income, 40,43,44,47,57 deprivation level, 3,4,35,[49][50][51][52]54,60,64 and tumor type 3,22,…”

Section: Gis Used To Analyze Health Systems or Patient Outcomesmentioning

confidence: 99%

See 1 more Smart Citation

Value of Geographical Information Systems in Analyzing Geographic Accessibility to Inform Radiotherapy Planning: A Systematic Review

Hande

Chan

Polo

2022

JCO Global Oncology

View full text Add to dashboard Cite

PURPOSE Vulnerable populations face geographical barriers in accessing radiotherapy (RT) facilities, resulting in heterogeneity of care received and cancer burden faced. We aimed to explore the current use of Geographical Information Systems (GIS) in access to RT and use these findings to create sustainable solutions against barriers for access in low- and middle-income countries. MATERIALS AND METHODS A systematic review using the PRISMA search strategy was done for studies using GIS to explore outcomes among patients with cancer. Included studies were reviewed and classified into three umbrella categories of how GIS has been used in studying access to RT. RESULTS Forty articles were included in the final review. Thirty-eight articles were set in high-income countries and two in upper-middle–income countries. Included studies were published from 2000 to 2020, and were comprised of patients with all-cancers combined, breast, colon, skin, lung, prostate, ovarian, and rectal carcinoma patients. Studies were categorized under three groups on the basis of how they used GIS in their analyses: to describe geographic access to RT, to associate geographic access to RT with outcomes, and for RT planning. Most studies fell under multiple categories. CONCLUSION Although this field is relative nascent, there is a wide array of functions possible through GIS for RT planning, including identifying high-risk populations, improving access in high-need areas, and providing valuable information for future resource allocation. GIS should be incorporated in future studies, especially set in low- and middle-income countries, which evaluate access to RT.

show abstract

Factors Influencing the Quality of Local Management of Ductal Carcinoma In Situ: A Cohort Study

Abstract: those living far from a designated breast care centre or having a low-case-volume surgeon were less likely to be considered for rt.

Cited by 3 publications

References 38 publications

Catching and monitoring clinical innovation through performance indicators. The case of the breast-conserving surgery indicator

Catching and monitoring clinical innovation through performance indicators. The case of the breast-conserving surgery indicator

Effect of Referral Patterns and Treatment Type on Oncologic Outcomes for Women with Ductal Carcinoma In Situ

Value of Geographical Information Systems in Analyzing Geographic Accessibility to Inform Radiotherapy Planning: A Systematic Review

Contact Info

Product

Resources

About