Quality indicators in breast cancer care

Turco, Marco Rosselli Del; Ponti, Antonio; Bick, Ulrich; Biganzoli, Laura; Cserni, Gábor; Cutuli, B.; Decker, Thomas; Dietel, Manfred; Gentilini, Oreste; Kuehn, Thorsten; Mano, Maria Piera; Mantellini, Paola; Marotti, Lorenza; Poortmans, Philip; Rank, Fritz; Roe, Helen; Scaffidi, E.; Hage, Jos A. van der; Viale, Giuseppe; Wells, Clive; Wełnicka-Jaśkiewicz, Marzena; Wengstöm, Y.; Cataliotti, Luigi

doi:10.1016/j.ejca.2010.06.119

Cited by 179 publications

(73 citation statements)

References 79 publications

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“…2–4 The previous lack of clear data has weakened the need for such a standard, but our findings here suggest that consideration of a reasonable delay threshold for surgery might be appropriate, as it has been for medical oncology and radiation oncology. Because only 1.2% and 1.5% of the SMDB and NCDB patients, respectively, had a TTS that was over 90 days, providing these few breast cancer patients the 3–5% survival benefit associated with reduced delay also seems achievable.…”

Section: Discussionmentioning

confidence: 80%

“…There has been a movement to include TTS as a breast cancer quality measure, 2–4 but only recently has this preoperative interval and the relationship of patient evaluation components to delay been comprehensively evaluated in Medicare patients. 5 We have found that while the interval between presentation and surgery in Medicare patients is short, that time interval has been rising, from 21 days in 1992 to 32 days in 2005.…”

Section: Introductionmentioning

confidence: 99%

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Time to Surgery and Breast Cancer Survival in the United States

et al. 2016

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Importance Time to surgery (TTS) is of concern to patients and clinicians, but controversy surrounds its impact on breast cancer survival. There remains little national data evaluating the association. Objective To investigate the relationship between the time from diagnosis to breast cancer surgery and survival, using separate analyses of two of the largest cancer databases in the United States. Design Two independent population-based studies of prospectively-collected national data utilizing the Surveillance Epidemiology and End Results (SEER)-Medicare-linked database (SMDB), and the National Cancer Database (NCDB). Setting The SMDB cohort included Medicare patients >65 years of age, and the NCDB cohort included patients cared for at Commission on Cancer-accredited facilities throughout the United States. Each analysis assessed overall survival as a function of time between diagnosis and surgery by evaluating intervals encompassing ≤30, 31–60, 61–90, 91–120, and 121–180 days in length, and disease-specific survival at 60-day intervals. Participants All patients were diagnosed with noninflammatory, nonmetastatic, invasive breast cancer and underwent surgery as initial treatment. Main Outcomes and Measures Overall and disease-specific survival as a function of time between diagnosis and surgery, after adjusting for patient, demographic and tumor-related factors. Results The SMDB cohort had 94,544 patients ≥66 years old, diagnosed 1992 – 2009. With each interval delay increase, overall survival was lower overall (hazard ratio [HR] 1.09, p<0.001), and in stage I (HR 1.13, p<0.001) and II (HR 1.06, p=0.010) patients. Breast cancer-specific mortality increased with each 60-d interval (subhazard ratio [sHR] 1.26, p= 0.03). The NCDB study evaluated 115,790 patients ≥18 years old, diagnosed 2003 – 2005. The overall mortality HR was 1.10 (p<0.001) for each increasing interval, significant in stages I (HR 1.16, p<0.001) and II (1.09, p<0.001) only, adjusting for demographic, tumor and treatment factors. Conclusions and Relevance Greater TTS confers lower overall and disease-specific survival, and a shortened delay is associated with benefits comparable to some standard therapies. Although time is required for preoperative evaluation and consideration of some options such as reconstruction, efforts to reduce TTS should be pursued where possible to enhance survival.

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Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Time to Surgery and Breast Cancer Survival in the United States

et al. 2016

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“…For example, axillary lymph node dissection (ALND) is not recommended for women with DCIS [8–10]. The International Cancer Screening Network (ICSN) oversees organised programmes that include quality monitoring of the process of screening and care.…”

Section: Introductionmentioning

confidence: 99%

International variation in management of screen-detected ductal carcinoma in situ of the breast

Ponti

Lynge

James

et al. 2014

European Journal of Cancer

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Background Ductal carcinoma in situ (DCIS) incidence has grown with the implementation of screening and its detection varies across International Cancer Screening Network (ICSN) countries. The aim of this survey is to describe the management of screen-detected DCIS in ICSN countries and to evaluate the potential for treatment related morbidity. Methods We sought screen-detected DCIS data from the ICSN countries identified during 2004–2008. We adopted standardised data collection forms and analysis and explored DCIS diagnosis and treatment processes ranging from pre-operative diagnosis to type of surgery and radiotherapy. Results Twelve countries contributed data from a total of 15 screening programmes, all from Europe except the United States of America and Japan. Among women aged 50–69 years, 7,176,050 screening tests and 5324 screen-detected DCIS were reported. From 21% to 93% of DCIS had a pre-operative diagnosis (PO); 67–90% of DCIS received breast conservation surgery (BCS), and in 41–100% of the cases this was followed by radiotherapy; 6.4–59% received sentinel lymph node biopsy (SLNB) only and 0.8–49% axillary dissection (ALND) with 0.6% (range by programmes 0–8.1%) being node positive. Among BCS patients 35% received SLNB only and 4.8% received ALND. Starting in 2006, PO and SLNB use increased while ALND remained stable. SLNB and ALND were associated with larger size and higher grade DCIS lesions. Conclusions Variation in DCIS management among screened women is wide and includes lymph node surgery beyond what is currently recommended. This indicates the presence of varying levels of overtreatment and the potential for its reduction.

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“…It has been set as a quality indicator for breast centers that this rate should exceed 70% for tumors smaller than 3 cm [6]. BCS rates in Turkey are not satisfactory and the underlying causes of this situation must be revealed.…”

Section: Resultsmentioning

confidence: 99%

Patients' Perspective: What has Changed in Deciding about Breast-Conserving Surgery for Early-Stage Breast Cancer in Turkey?

2018

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Background: This study aims to describe patients' perception of early breast cancer, factors influencing the choice of operation, patients' sources of information about the disease and the seriousness with which this information is considered, and to address what surgeons can do to enlighten their patients prior to decision-making. Methods: Patients were asked to complete a questionnaire consisting of 3 sections: The first section addressed influential factors during the decision-making process; the second pertained to the role of surgeons or health facilities in the process; and the third asked patients to revisit their initial choice of surgery. Results: 237 patients were included in the study. Statistical analyzes regarding demographic features showed that nulliparous, younger than 50 years, never or <5 years married, highly educated, business-owning, employed, and stage I breast cancer patients preferred breast-conserving surgery (BCS) to mastectomy. Conclusion: Although the rate of BCS is a technical quality indicator for breast cancer centers, providing sufficient patient counseling, involving the patient in the decision-making process, and offering every possible surgical option are key to improving quality of life. Systematic counseling should be provided to breast cancer patients who have primary tumors that are eligible for BCS.

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Quality indicators in breast cancer care

Cited by 179 publications

References 79 publications

Time to Surgery and Breast Cancer Survival in the United States

Time to Surgery and Breast Cancer Survival in the United States

International variation in management of screen-detected ductal carcinoma in situ of the breast

Patients' Perspective: What has Changed in Deciding about Breast-Conserving Surgery for Early-Stage Breast Cancer in Turkey?

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