1
|
van Walle L, Verhoeven D, Marotti L, Ponti A, Tomatis M, Rubio IT. Trends and variation in treatment of early breast cancer in European certified breast centres: an EUSOMA-based analysis. Eur J Cancer 2023; 192:113244. [PMID: 37633095 DOI: 10.1016/j.ejca.2023.113244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/07/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Practice indicators (PI) measure provided care making use of real-world data. This study describes trends and variations in adjuvant treatment of early breast cancer (EBC) using the European Society of Breast Cancer Specialists (EUSOMA) database. METHODS The analysis was conducted on anonymous cumulative data registered by 56 certified breast centres, which all entered at least 500 new diagnoses in the database in the 10-year period 2010-2019. Practice trends of radiotherapy, endocrine treatment, chemotherapy, and anti-HER2 therapy were evaluated. The association with age group (<50, 50-69, ≥70) and geographical area of the centre (Northern, Central, Southern Europe; NE, CE, SE) was assessed with the Pearson Chi2 test for independence in contingency tables. RESULTS In total, 150,150 patients with EBC were selected. Overall, radiotherapy was administered more frequently in NE centres, and conversely, endocrine, chemo-, and anti-HER2 therapy were used more frequently in SE centres (p<0.001). 46.9% of the pN1 patients received postmastectomy radiotherapy, with significant differences by age and geographical region (p < 0.001). Adjuvant endocrine treatment for endocrine-sensitive carcinoma in situ was administered in 46.1%, with a decreasing trend during the study period (58.5-34.5%; p < 0.001). Anti-HER2 therapy was delivered in 75.6% of all patients with HER2BC T1a/bN0, patients older than 70 received anti-HER2 in 67.6% in SE compared to 31.3% in NE centres. CONCLUSION Important variations in EBC management between European certified breast centres have been demonstrated. PI using real-world data can help to monitor, evaluate, and eventually guide and align good clinical practice in the management of breast cancer.
Collapse
Affiliation(s)
| | - Didier Verhoeven
- Department of Medical Oncology, Breast Centre Voorkempen, AZ Klina, Brasschaat, Belgium; University of Antwerp, Antwerpen, Belgium
| | - Lorenza Marotti
- European Society of Breast Cancer Specialists (EUSOMA), Florence, Italy
| | - Antonio Ponti
- CPO Piemonte, Turin and European Society of Breast Cancer Specialists (EUSOMA), Florence, Italy
| | - Mariano Tomatis
- European Society of Breast Cancer Specialists (EUSOMA), Florence, Italy
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| |
Collapse
|
2
|
Duffield JA, Blanch AJ, Bochner MA. Breast cancer care and surgery in Australia and New Zealand: compliance of the BreastSurgANZ quality audit with international standards. ANZ J Surg 2023; 93:881-888. [PMID: 36856199 DOI: 10.1111/ans.18347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND The Breast Surgeons of Australia and New Zealand (BreastSurgANZ) Quality Audit (BQA) of Breast Cancer Care is a prospective population-based database designed for annual audit of compliance with internally derived Quality Indicators (QI)s. While there is no international consensus for QIs, audit against an external international benchmark is possible through use of QIs defined by the 2017 European Society of Breast Cancer Specialists (EUSOMA) Guidelines. METHODS BQA data from 29,088 female patients between 1/1/2018 and 31/12/2019 were stratified by the EUSOMA definition of low-volume hospitals (LVH <150 patients p.a.) and high-volume hospitals (HVH ≥150 patients p.a.), and percentage compliance (±95% CI) with 14 mandatory EUSOMA QI sub-parts were determined. RESULTS ANZ LVH met the quality threshold for 10, and HVH for 8 EUSOMA QI that assessed MDT, surgical approach, adjuvant radiotherapy in the LVH setting, avoidance of overtreatment, and use of endocrine therapy. ANZ did not meet the quality thresholds for QIs assessing use of neoadjuvant chemotherapy, and adjuvant radiotherapy in the HVH setting. CONCLUSION Breast cancer care in ANZ is comparable with an international standard. ANZ surgeons performed at a high standard in discussion of breast cancer patients by MDT, and appropriate use of adjuvant radiotherapy by LVH. Improvements can be made in completeness of data capture, and inclusion of genetic syndrome and Ki67% in data collection. Due to the rapid evolution of breast cancer treatments, there is need for contemporary update of QI relating to the use of neoadjuvant systemic therapies.
Collapse
Affiliation(s)
- Jaime A Duffield
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Adam J Blanch
- Breast Quality Audit, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Melissa A Bochner
- Medical School, The University of Adelaide, Adelaide, South Australia, Australia.,Breast Quality Audit Steering Committee, Breast Surgeons of Australia and New Zealand, Sydney, New South Wales, Australia
| |
Collapse
|
3
|
The impact of the SARS-COV-2 pandemic on the quality of breast cancer care in EUSOMA-certified breast centres. Eur J Cancer 2022; 177:72-79. [PMID: 36332437 PMCID: PMC9554010 DOI: 10.1016/j.ejca.2022.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/06/2023]
Abstract
AIMS We analysed the impact of the SARS-CoV-2 pandemic (COVID-19) on the quality of breast cancer care in certified EUSOMA (European Society of Breast Cancer Specialists) breast centres. MATERIALS AND METHODS The results of the EUSOMA quality indicators were compared, based on pseudonymised individual records, for the periods 1 March 2020 till 30 June 2020 (first COVID-19 peak in most countries in Europe) and 1 March 2019 till 30 June 2019. In addition, a questionnaire was sent to the participating Centres for investigating the impact of the COVID-19 pandemic on the organisation and the quality of breast cancer care. RESULTS Forty-five centres provided data and 31 (67%) responded to the questionnaire. The total number of new cases dropped by 19% and there was a small significant higher tumour (p = 0.003) and lymph node (p = 0.011) stage at presentation. Comparing quality indicators (12,736 patients) by multivariable analysis showed mostly non-significant differences. Surgery could be performed in a COVID-free zone in 94% of the centres, COVID testing was performed before surgery in 96% of the centres, and surgical case load was reduced in 55% of the centres. Modifications of the indications for neoadjuvant endocrine therapy, chemotherapy, and targeted therapy were necessary in 23%, 23%, and 10% of the centres; changes in indications for adjuvant endocrine, chemo-, targeted, immune, and radiotherapy in 3%, 19%, 3%, 6%, and 10%, respectively. CONCLUSION Quality of breast cancer care was well maintained in EUSOMA breast centres during the first wave of the COVID-19 pandemic. A small but significantly higher tumour and lymph node stage at presentation was observed.
Collapse
|
4
|
Ciabattoni A, Gregucci F, D’Ermo G, Dolfi A, Cucciarelli F, Palumbo I, Borghesi S, Gava A, Cesaro GM, Baldissera A, Giammarino D, Daidone A, Maurizi F, Mignogna M, Mazzuoli L, Ravo V, Falivene S, Pedretti S, Ippolito E, Barbarino R, di Cristino D, Fiorentino A, Aristei C, Ramella S, D’Angelillo RM, Meattini I, Iotti C, Donato V, Formenti SC. Patterns of Care for Breast Radiotherapy in Italy: Breast IRRadiATA (Italian Repository of Radiotherapy dATA) Feasibility Study. Cancers (Basel) 2022; 14:cancers14163927. [PMID: 36010920 PMCID: PMC9405796 DOI: 10.3390/cancers14163927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Breast cancer is the most common cancer in women worldwide, with a high prevalence and incidence, configuring an important issue in cancer epidemiology. Over the years, the combination of primary and secondary prevention programs and multidisciplinary treatment approaches has improved the overall survival (OS) and quality of life (QoL) of patients. However, although treatment pathways should be standardized in evidence-based medicine, clinical practice (real-world evidence) may differ from expected. To improve OS and QoL, having a clear picture of the Patterns of Care actually applied is essential. To this aim, Breast IRRADIATA (Italian Repository of RADIotherapy dATA), a collaborative nationwide project, was developed as a simple tool to probe the current pattern of radiotherapy care in Italy and tested in a feasibility study. This pilot feasibility of IRRADIATA encourages a larger application of this tool nationwide and opens the way to the assessment of pattern of care radiotherapy directed to other cancers. Abstract Aim. Breast IRRADIATA (Italian Repository of RADIotherapy dATA) is a collaborative nationwide project supported by the Italian Society of Radiotherapy and Clinical Oncology (AIRO) and the Italian League Against Cancer (LILT). It focuses on breast cancer (BC) patients treated with radiotherapy (RT) and was developed to create a national registry and define the patterns of care in Italy. A dedicated tool for data collection was created and pilot tested. The results of this feasibility study are reported here. Methods. To validate the applicability of a user-friendly data collection tool, a feasibility study involving 17 Italian Radiation Oncology Centers was conducted from July to October 2021, generating a data repository of 335 BC patients treated between January and March 2020, with a minimum follow-up time of 6 months. A snapshot of the clinical presentation, treatment modalities and radiotherapy toxicity in these patients was obtained. A Data Entry Survey and a Satisfaction Questionnaire were also sent to all participants. Results. All institutions completed the pilot study. Regarding the Data Entry survey, all questions achieved 100% of responses and no participant reported spending more than 10 min time for either the first data entry or for the updating of follow-up. Results from the Satisfaction Questionnaire revealed that the project was described as excellent by 14 centers (82.3%) and good by 3 (17.7%). Conclusion. Current knowledge for the treatment of high-prevalence diseases, such as BC, has evolved toward patient-centered medicine, evidence-based care and real-world evidence (RWE), which means evidence obtained from real-world data (RWD). To this aim, Breast IRRADIATA was developed as a simple tool to probe the current pattern of RT care in Italy. The pilot feasibility of IRRADIATA encourages a larger application of this tool nationwide and opens the way to the assessment of the pattern of care radiotherapy directed to other cancers.
Collapse
Affiliation(s)
- Antonella Ciabattoni
- Department of Radiation Oncology, Ospedale San Filippo Neri, ASL Roma 1, 00135 Roma, Italy
| | - Fabiana Gregucci
- Department of Radiation Oncology, Ospedale Generale Regionale “F. Miulli”, Acquaviva delle Fonti, 70021 Bari, Italy
- Correspondence: or
| | - Giuseppe D’Ermo
- Department of Surgery, “Pietro Valdoni”, Universitá di Roma “La Sapienza”, 00185 Roma, Italy
- LILT, Lega Italiana Contro i Tumori, Sede Centrale Via A. Torlonia, 15, 00161 Roma, Italy
| | - Alessandro Dolfi
- Department of Radiation Oncology, Ospedale San Filippo Neri, ASL Roma 1, 00135 Roma, Italy
| | - Francesca Cucciarelli
- Department of Radiation Oncology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, 61029 Ancona, Italy
| | - Isabella Palumbo
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, 06123 Perugia, Italy
| | - Simona Borghesi
- Department of Radiation Oncology, Azienda USL Toscana Sud Est, Sede Operativa Valdarno, 52100 Arezzo Valdarno, Italy
| | - Alessandro Gava
- Department of Radiation Oncology, Azienda Ospedaliera ULSS 9, 31100 Treviso, Italy
| | | | | | - Daniela Giammarino
- Department of Radiation Oncology, Azienda Ospedaliera San Camillo Forlanini, 00152 Roma, Italy
| | - Antonino Daidone
- Department of Radiation Oncology, Centro San Gaetano, Sede di Bagheria e Sede di Mazzara del Vallo, 35121 Palermo e Trapani, Italy
| | - Francesca Maurizi
- Department of Radiation Oncology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, 61029 Pesaro, Italy
| | - Marcello Mignogna
- Department of Radiation Oncology, Azienda Ospedaliera USL Toscana Nord Ovest, 56121 Lucca, Italy
| | - Lidia Mazzuoli
- Department of Radiation Oncology, Azienda Ospedaliera ASL Viterbo, 01100 Viterbo, Italy
| | - Vincenzo Ravo
- Department of Radiation Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, 80131 Napoli, Italy
| | - Sara Falivene
- Department of Radiation Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, 80131 Napoli, Italy
| | - Sara Pedretti
- Department of Radiation Oncology, ASST Spedali Civili Brescia, 25123 Brescia, Italy
| | - Edy Ippolito
- Department of Radiation Oncology, Università Campus Bio-Medico e Fondazione Campus Bio-Medico, 00128 Roma, Italy
| | - Rosaria Barbarino
- Department of Radiation Oncology, Fondazione PTV, Policlinico Tor Vergata, 75013 Roma, Italy
| | - Daniela di Cristino
- Department of Radiation Oncology, Ospedale San Filippo Neri, ASL Roma 1, 00135 Roma, Italy
| | - Alba Fiorentino
- Department of Radiation Oncology, Ospedale Generale Regionale “F. Miulli”, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, 06123 Perugia, Italy
| | - Sara Ramella
- Department of Radiation Oncology, Università Campus Bio-Medico e Fondazione Campus Bio-Medico, 00128 Roma, Italy
| | | | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences “M. Serio”, Department of Oncology, Radiation Oncology Unit, Ospedale Universitario Careggi, Universitá di Firenze, 50134 Firenze, Italy
| | - Cinzia Iotti
- Radiation Therapy Unit, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
- AIRO President, AIRO-Associazione Italiana di Radioterapia ed Oncologia Clinica, Piazza della Repubblica 32, 20124 Milano, Italy
| | - Vittorio Donato
- Department of Radiation Oncology, Azienda Ospedaliera San Camillo Forlanini, 00152 Roma, Italy
- AIRO Past President, AIRO-Associazione Italiana di Radioterapia ed Oncologia Clinica, Piazza della Repubblica 32, 20124 Milano, Italy
| | - Silvia Chiara Formenti
- Department of Radiation Oncology, Weill Cornell Medicine—New York Presbyterian Hospital, New York, NY 10065, USA
| |
Collapse
|
5
|
Houzard S, Courtois E, Le Bihan Benjamin C, Erbault M, Arnould L, Barranger E, Coussy F, Couturaud B, Cutuli B, de Cremoux P, de Reilhac P, de Seze C, Foucaut AM, Gompel A, Honoré S, Lesur A, Mathelin C, Verzaux L, Bousquet PJ. Monitoring breast cancer care quality at national and local level using the French National Cancer Cohort. Clin Breast Cancer 2022; 22:e832-e841. [DOI: 10.1016/j.clbc.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 11/25/2022]
|
6
|
Baral S, Silwal SR, Shrestha UM, Lamichhane D. Evaluation of Quality Indicators of Breast Cancer Management at a Tertiary Cancer Center in Nepal. JCO Glob Oncol 2022; 8:e2100303. [PMID: 35298295 PMCID: PMC8955076 DOI: 10.1200/go.21.00303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/03/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Breast cancer is the second commonest cancer among female in Nepal. This is our first attempt to audit breast cancer management in our institute and compare with standard quality indicators (QIs) available. METHODS The retrospective study included 104 female patients with breast cancer who had taken treatment at Bhaktapur Cancer Hospital in 1 year. Participants were selected on the basis of convenience sampling. Of 33 QIs in breast cancer management according to European Society of Breast Cancer Specialists guidelines, 19 QIs were chosen relevant to our setup. These QIs were calculated for all patients and compared with the European Society of Breast Cancer Specialists standard target. Frequencies and percentages were calculated and presented in tables. Binomial 95% of the rates for QI adherence were also calculated for each QI. RESULTS One hundred four patients had a median age of 47.5 years (range 24-70 years). Applicable QIs were in the range of 5-15 with a mean of 9.66 per patient. Of 19 evaluable QIs, very high adherence rates were observed in six QIs, high adherence in three Qis, and low adherences in 10 QIs. High adherence rates were for QI 5 and QI 10a, which were 88.46% and 94.73%, respectively. The low compliance was for QI 1, QI 4a, QI 8, QI 9d, QI 10b, QI 11a, QI 11b, QI 13b, QI 13e, and 14b, which were 53.84%, 78.21%, 0%, 83.16%, 76.92%, 36.0%, 33.33%, 4.76%, 30.55%, and 10.81%, respectively. CONCLUSION There are several QIs that have low levels of adherence in our setting and suggest that there is significant room for improvement. We will be continuing auditing these QIs regularly to improve our quality of care.
Collapse
Affiliation(s)
- Shweta Baral
- Clinical Oncologist, Bhaktapur Cancer Hospital, Bhaktapur, Nepal
| | | | | | - Deep Lamichhane
- Surgical Oncologist, Bhaktapur Cancer Hospital, Bhaktapur, Nepal
| |
Collapse
|
7
|
Effects of Out-of-Hospital Continuous Nursing on Postoperative Breast Cancer Patients by Medical Big Data. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9506915. [PMID: 35035864 PMCID: PMC8758290 DOI: 10.1155/2022/9506915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/20/2021] [Indexed: 12/15/2022]
Abstract
This study aimed to explore the application value of the intelligent medical communication system based on the Apriori algorithm and cloud follow-up platform in out-of-hospital continuous nursing of breast cancer patients. In this study, the Apriori algorithm is optimized by Amazon Web Services (AWS) and graphics processing unit (GPU) to improve its data mining speed. At the same time, a cloud follow-up platform-based intelligent mobile medical communication system is established, which includes the log-in, my workstation, patient records, follow-up center, satisfaction management, propaganda and education center, SMS platform, and appointment management module. The subjects are divided into the control group (routine telephone follow-up, 163) and the intervention group (continuous nursing intervention, 216) according to different nursing methods. The cloud follow-up platform-based intelligent medical communication system is used to analyze patients' compliance, quality of life before and after nursing, function limitation of affected limb, and nursing satisfaction under different nursing methods. The running time of Apriori algorithm is proportional to the data amount and inversely proportional to the number of nodes in the cluster. Compared with the control group, there are statistical differences in the proportion of complete compliance data, the proportion of poor compliance data, and the proportion of total compliance in the intervention group (P < 0.05). After the intervention, the scores of the quality of life in the two groups are statistically different from those before treatment (P < 0.05), and the scores of the quality of life in the intervention group were higher than those in the control group (P < 0.05). The proportion of patients with limited and severely limited functional activity of the affected limb in the intervention group is significantly lower than that in the control group (P < 0.05). The satisfaction rate of postoperative nursing in the intervention group is significantly higher than that in the control group (P < 0.001), and the proportion of basically satisfied and dissatisfied patients in the control group was higher than that in the intervention group (P < 0.05).
Collapse
|
8
|
Kapur H, Chen L, Warburton R, Pao JS, Dingee C, Kuusk U, Bazzarelli A, McKevitt E. De-Escalating Breast Cancer Surgery: Should We Apply Quality Indicators from Other Jurisdictions in Canada? Curr Oncol 2021; 29:144-154. [PMID: 35049687 PMCID: PMC8775231 DOI: 10.3390/curroncol29010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/19/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
Quality Indicators (QIs), including the breast-conserving surgery (BCS) rate, were published by the European and American Breast Cancer Societies and this study assesses these in a Canadian population to look for opportunities to de-escalate surgery. A total of 2311 patients having surgery for unilateral, unifocal breast cancer between 2013 and 2017 were identified and BCS QIs calculated. Reasons for mastectomy had been prospectively collected with synoptic operative reporting. Our BCS rate for invasive cancer < 3 cm was 77.1%, invasive cancer < 2 cm was 84.1%, and DCIS < 2 cm was 84.9%. There was no statistically significant change in BCS rates over a five-year period, but there was a reduction in contralateral prophylactic mastectomies (CPM) from 28% in 2013 to 16% in 2017 (p < 0.001). Trend analysis looking at tumour size and medical need for mastectomy indicated that 80% of patients at our centre would be eligible for BCS with tumour cut off of 2.5 cm. Our institution met American but not European QI standards for BCS rates, potentially indicating a difference in patient demographics compared to Europe. Our results support the understanding that BCS rates are influenced by multiple factors and are challenging to compare across jurisdictions. CPM rates may offer a more actionable opportunity to de-escalate surgery for breast cancer.
Collapse
Affiliation(s)
- Hannah Kapur
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada; (H.K.); (R.W.); (J.-S.P.); (C.D.); (U.K.); (A.B.)
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada;
| | - Leo Chen
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada;
| | - Rebecca Warburton
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada; (H.K.); (R.W.); (J.-S.P.); (C.D.); (U.K.); (A.B.)
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada;
| | - Jin-Si Pao
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada; (H.K.); (R.W.); (J.-S.P.); (C.D.); (U.K.); (A.B.)
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada;
| | - Carol Dingee
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada; (H.K.); (R.W.); (J.-S.P.); (C.D.); (U.K.); (A.B.)
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada;
| | - Urve Kuusk
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada; (H.K.); (R.W.); (J.-S.P.); (C.D.); (U.K.); (A.B.)
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada;
| | - Amy Bazzarelli
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada; (H.K.); (R.W.); (J.-S.P.); (C.D.); (U.K.); (A.B.)
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada;
| | - Elaine McKevitt
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada; (H.K.); (R.W.); (J.-S.P.); (C.D.); (U.K.); (A.B.)
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada;
- Correspondence:
| |
Collapse
|
9
|
van Walle L, Punie K, Van Eycken E, de Azambuja E, Wildiers H, Duhoux FP, Vuylsteke P, Barbeaux A, Van Damme N, Verhoeven D. Assessment of potential process quality indicators for systemic treatment of breast cancer in Belgium: a population-based study. ESMO Open 2021; 6:100207. [PMID: 34273808 PMCID: PMC8319479 DOI: 10.1016/j.esmoop.2021.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/28/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022] Open
Abstract
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 = 9855). Clinical stage (cStage) I patients (n = 17 116) were staged with positron emission tomography/computed tomography. Among patients who were pT1aN0 human epidermal growth factor receptor 2 (HER2) positive (n = 47), 25.5% (n = 12) received adjuvant trastuzumab. Among patients with de novo metastatic luminal A/B-like HER2-negative BC (n = 295), 17.3% (n = 51) received upfront chemotherapy. (Neo)adjuvant chemotherapy was administered in 52.4% (n = 12 592) of operated women with cStage I-III, in 37.0% (n = 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 = 3591), 81.7% (n = 2932) continued treatment for ≥4.5 years. Among patients in cStage I-III older than 70 years (n = 8544), 19.0% (n = 1622) received (neo)adjuvant chemotherapy, whereas among patients with cStage I-III luminal A/B-like HER2-negative BC (n = 1388), 13.0% (n = 181) received (neo)adjuvant chemotherapy. In patients with cStage I-II luminal A/B-like HER2-negative BC older than 70 years (n = 1477), 11.6% (n = 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.
Collapse
Affiliation(s)
| | - K Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | | | - E de Azambuja
- Department of Medical Oncology, Institut Jules Bordet, Brussels, Belgium; Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - H Wildiers
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - F P Duhoux
- Department of Medical Oncology, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - P Vuylsteke
- Department of Medical Oncology, CHU UCL Namur, Site Ste Elisabeth, Namur, Belgium; University of Botswana, Botswana, Belgium
| | - A Barbeaux
- Department of Medical Oncology, CHR Verviers East Belgium, Verviers, Belgium
| | | | - D Verhoeven
- Department of Medical Oncology, AZ Klina, Brasschaat, Belgium; University of Antwerp, Antwerp, Belgium
| |
Collapse
|
10
|
Luyckx A, Wyckmans L, Bonte AS, Trinh XB, van Dam PA. Acceptability of quality indicators for the management of endometrial, cervical and ovarian cancer: results of an online survey. BMC Womens Health 2020; 20:151. [PMID: 32703282 PMCID: PMC7376904 DOI: 10.1186/s12905-020-00999-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/18/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Measuring quality indicators (QI's) is a tool to improve the quality of care. The aim of this study was to evaluate the acceptability of 36 QI's, defined after a literature search for the management of endometrial, cervical and ovarian cancer. Relevant specialists in the field of interest were surveyed. METHODS To quantify the opinions of these specialists, an online survey was sent out via mailing to members of gynaecological or oncological societies. The relevance of each QI was questioned on a scale from one to five (1 = irrelevant, 2 = less relevant, 3 = no opinion/neutral, 4 = relevant, 5 = very relevant). If a QI received a score of 4 or 5 in 65% or more of the answers, we state that the respondents consider this QI to be sufficiently relevant to use in daily practice. RESULTS The survey was visited 238 times and resulted in 53 complete responses (29 Belgian, 24 other European countries). The majority of the specialists were gynaecologists (45%). Five of the 36 QI's (13,9%) did not reach the cut-off of 65%: referral to a tertiary center, preoperative staging of endometrial cancer by MRI, preoperative staging of cervical cancer by positron-emission tomography, incorporation of intracavitary brachytherapy in the treatment of cervical cancer, reporting ASA and WHO score for each patient. After removing the 5 QI's that were not considered as relevant by the specialists and 3 additional 3 QI's that we were considered to be superfluous, we obtained an optimized QI list. CONCLUSION As QI's gain importance in gynecological oncology, their use can only be of value if they are universally interpreted in the same manner. We propose an optimized list of 28 QI's for the management of endometrial, cervical and ovarian cancer which responders of our survey found relevant. Further validation is needed to finalize and define a set of QI's that can be used in future studies, audits and benchmarking.
Collapse
Affiliation(s)
- Annemie Luyckx
- Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Wilrijkstraat 10, B2650, Edegem, Belgium
| | - Leen Wyckmans
- Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Wilrijkstraat 10, B2650, Edegem, Belgium
| | - Anne-Sophie Bonte
- Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Wilrijkstraat 10, B2650, Edegem, Belgium
| | - Xuan Bich Trinh
- Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Wilrijkstraat 10, B2650, Edegem, Belgium
- Centre for Oncological Research (CORE), University of Antwerp, B2610, Wilrijk, Belgium
| | - Peter A van Dam
- Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Wilrijkstraat 10, B2650, Edegem, Belgium.
- Centre for Oncological Research (CORE), University of Antwerp, B2610, Wilrijk, Belgium.
| |
Collapse
|
11
|
Perhavec A, Milicevic S, Peric B, Zgajnar J. Does regular quality control improve the quality of surgery in Slovenian breast cancer screening program? Radiol Oncol 2020; 54:488-494. [PMID: 32463384 PMCID: PMC7585346 DOI: 10.2478/raon-2020-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/26/2020] [Indexed: 12/03/2022] Open
Abstract
Background The aim of our study was to evaluate the quality of surgery of Slovenian breast cancer screening program (DORA) using the requested EU standards. Furthermore, we investigated whether regular quality control over the 3-year period improved the quality of surgical management. Patients and methods Patients who required surgical management within DORA between January 1st, 2016 and December 31st, 2018 were included in the retrospective study. Quality indicators (QIs) were adjusted mainly according to European Society of Breast Cancer Specialists (EUSOMA) and European Breast Cancer Network (EBCN) recommendations. Five QIs for therapeutic and two for diagnostic surgeries were selected. Additionally, variability in achieving the requested QIs among surgeons was analysed. Results Between 2016 and 2018, 14 surgeons performed 1421 breast procedures in 1398 women. There were 1197 therapeutical (for proven breast cancer) and 224 diagnostic surgical interventions respectively. Overall, the minimal standard was met in two QIs for therapeutic and none for diagnostic procedures. A statistically significant improvement in three QIs for therapeutic and in one QI for diagnostic procedures was observed however, indicating that regular quality control improves the quality of surgery. A high variability in achieving the requested QIs was observed among surgeons, which remained high throughout the study period. Conclusions Adherence to all selected surgical QIs in patients from screening program is difficult to achieve, especially to those specifically defined for screen-detected lesions. Regular quality control may improve results over time. Reducing the number of surgeons dedicated to breast pathology may reduce variability of management inside the institution.
Collapse
Affiliation(s)
- Andraz Perhavec
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sara Milicevic
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Barbara Peric
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Janez Zgajnar
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
12
|
Cha J, McKevitt E, Pao JS, Dingee C, Bazzarelli A, Warburton R. Access to surgery following centralization of breast cancer surgical consultations. Am J Surg 2020; 219:831-835. [DOI: 10.1016/j.amjsurg.2020.01.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 12/12/2022]
|
13
|
Present clinical practice of breast cancer radiotherapy in Italy: a nationwide survey by the Italian Society of Radiotherapy and Clinical Oncology (AIRO) Breast Group. Radiol Med 2020; 125:674-682. [DOI: 10.1007/s11547-020-01147-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
|
14
|
Compliance with clinical guidelines for breast cancer management: A population-based study of quality-of-care indicators in France. PLoS One 2019; 14:e0224275. [PMID: 31644603 PMCID: PMC6808419 DOI: 10.1371/journal.pone.0224275] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/09/2019] [Indexed: 12/09/2022] Open
Abstract
Background The 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. Methods 1 560 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. Results The 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. Conclusion This 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.
Collapse
|
15
|
Pons-Tostivint E, Daubisse-Marliac L, Grosclaude P, Oum Sack E, Goddard J, Morel C, Dunet C, Sibrac L, Lagadic C, Bauvin E, Bergé Y, Bernard-Marty C, Vaysse C, Lacaze JLL. Multidisciplinary team meeting and EUSOMA quality indicators in breast cancer care: A French regional multicenter study. Breast 2019; 46:170-177. [PMID: 31226572 DOI: 10.1016/j.breast.2019.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/29/2019] [Accepted: 06/03/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION We evaluate breast cancer (BC) pathway at a regional level including public, private and university institutions. We assessed the quality of multidisciplinary team meetings (MTM) and compliance with a panel of European high-quality indicators (EUSOMA QIs). METHODS We conducted a retrospective multicenter (n = 20) study in the largest health care region in France. Between January and April 2015, we included all patients discussed at an MTM after a diagnosis of BC (n = 619). We analyzed quality of MTM by assessing the quorum, the reliability of data transcription and the exhaustivity of pre-therapeutic MTM. We then analyzed the compliance with a selected panel of 16 EUSOMA QIs. RESULTS During MTM discussion, data were more than 95% consistent with medical records for 9/11 items. Pre-operative tumor histology (90.6%) and post-operative resection margins (84.3%) were the least concordant between medical records and MTM. Minimum standards as defined by EUSOMA were reached for 11/16 QIs, but not reached for pathology reports in non-invasive BC (78.2%), proportion of exclusive sentinel lymph node biopsies in patients with clinically negative axilla (85.2%), performing adjuvant chemotherapy (76.6%), and proportion of patients discussed in pre-therapeutic and post-operative MTM (63.5%). CONCLUSIONS In this multicentric study evaluating the quality of BC care with a representative sample of institutions, compliance with EUSOMA indicators was satisfactory for all type of institutions. However, too few patients were discussed in pre-therapeutic MTM (especially in non-university hospitals 43.7% [39.4-48.1]) versus 88.7% for others [82.2-95.1]) and data transcription was likely responsible for up to 15% of discordance.
Collapse
Affiliation(s)
- E Pons-Tostivint
- Department of Medical Oncology, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France; Occitanie Regional Cancer Network (Onco-Occitanie), 31100, Toulouse, France.
| | - L Daubisse-Marliac
- Claudius Regaud Institute, IUCT-Oncopole, Tarn Cancer Registry, Toulouse, F-31059, France; LEASP, UMR 1027 Inserm, Université de Toulouse III, F-31000, France
| | - P Grosclaude
- Claudius Regaud Institute, IUCT-Oncopole, Tarn Cancer Registry, Toulouse, F-31059, France
| | - E Oum Sack
- Occitanie Regional Cancer Network (Onco-Occitanie), 31100, Toulouse, France
| | - J Goddard
- Occitanie Regional Cancer Network (Onco-Occitanie), 31100, Toulouse, France
| | - C Morel
- Occitanie Regional Cancer Network (Onco-Occitanie), 31100, Toulouse, France
| | - C Dunet
- Occitanie Regional Cancer Network (Onco-Occitanie), 31100, Toulouse, France
| | - L Sibrac
- Department of Medical Oncology, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France
| | - C Lagadic
- Claudius Regaud Institute, IUCT-Oncopole, Tarn Cancer Registry, Toulouse, F-31059, France
| | - E Bauvin
- Occitanie Regional Cancer Network (Onco-Occitanie), 31100, Toulouse, France
| | - Y Bergé
- Department of Medical Oncology, Clinique Claude-Bernard, Albi, France
| | - C Bernard-Marty
- Department of Medical Oncology, ONCORAD, Clinique Pasteur, Toulouse, France
| | - C Vaysse
- Toulouse University Hospital Center (CHU Toulouse), IUCT-Oncopole, 31000, Toulouse, France
| | - J L L Lacaze
- Department of Medical Oncology, Claudius Regaud Institute, IUCT-Oncopole, Toulouse, France
| | | |
Collapse
|
16
|
Kreienberg R, Wöckel A, Wischnewsky M. Highly significant improvement in guideline adherence, relapse-free and overall survival in breast cancer patients when treated at certified breast cancer centres: An evaluation of 8323 patients. Breast 2018; 40:54-59. [PMID: 29698925 DOI: 10.1016/j.breast.2018.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/15/2018] [Accepted: 04/02/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Certified multi-disciplinary breast cancer centres (CBCs) have been established worldwide. Development of CBCs, guideline-adherent systemic therapy and surgical management should now show an impact on outcomes. This analysis aimed to investigate whether guideline adherence (GA) rates, relapse-free survival (RFS) and overall survival (OS) have significantly improved at CBCs compared to the pre-certification period. MATERIALS AND METHODS 8323 patients with primary breast cancer were treated in 17 German CBCs, which had been certified between 2003 and 2007 [2003 (n = 1), 2004 (n = 6), 2005 (n = 3), 2006 (n = 6) and 2007 (n = 1)]. 3544 patients (42.6%) were treated before certification and 4779 patients (57.4%) after certification. RESULTS AND CONCLUSION A highly significant (p < 0.001) difference in 100%-GA was found between the various hospitals before certification (min 25.0%; max 54.6%). In 2008, when all participating hospitals were certified, the GA rate was 61.8% (min 39.5%, max 74.4%) and 69.2% (min 45.9%, max 86.4%) for patients <75 y (n = 6675). The difference between pre-certification 100%-GA (46.9%) and post-certification (57.2%) was highly significant (p < 0.001). RFS and OS were both significantly better after certification compared to the pre-certification period (RFS: HR = 0.79; 95% CI: 0.68-0.92; p = 0.003; OS: HR = 0.75; 95% CI: 0.65-0.85; p < 0.001). 5-year RFS (OS) of patients <75 y was 89.6% (85.4%) pre-certification and 91.4% (89.5%) post-certification. Since improvement in GA and outcomes correlated as well, GA remains a highly significant prognostic factor for RFS and OS regardless of NPI, intrinsic subtype and adjuvant systemic therapy. This suggests that the certification process is strongly associated with improvements in outcome.
Collapse
|
17
|
Schnapper G, Marotti L, Casella D, Mano MP, Mansel RE, Ponti A. Data managers: A survey of the European Society of Breast Cancer Specialists in certified multi-disciplinary breast centers. Breast J 2018; 24:811-815. [PMID: 29687531 DOI: 10.1111/tbj.13043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 06/16/2017] [Accepted: 06/21/2017] [Indexed: 11/28/2022]
Abstract
The European Society of Breast Cancer Specialists (EUSOMA) requires that the breast centers' core team includes a trained person responsible for data collection and analysis. We addressed a questionnaire to the data managers of the EUSOMA breast centers network in order to acquire information with regard to their education, training, role, activity, recognition, and satisfaction. Breast centers' data managers are highly educated individuals with a variety of backgrounds carrying out, more frequently part-time and as temporary employees, a job for which they received little specific training. These findings support the importance of defining a core curriculum and a training program.
Collapse
Affiliation(s)
| | | | - Denise Casella
- CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | - Maria P Mano
- CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy.,School of Medicine, University of Turin, Turin, Italy
| | - Robert E Mansel
- EUSOMA, Florence, Italy.,School of Medicine, Cardiff University, Cardiff, UK
| | - Antonio Ponti
- EUSOMA, Florence, Italy.,CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | | |
Collapse
|
18
|
Landercasper J, Fayanju OM, Bailey L, Berry TS, Borgert AJ, Buras R, Chen SL, Degnim AC, Froman J, Gass J, Greenberg C, Mautner SK, Krontiras H, Ramirez LD, Sowden M, Wexelman B, Wilke L, Rao R. Benchmarking the American Society of Breast Surgeon Member Performance for More Than a Million Quality Measure-Patient Encounters. Ann Surg Oncol 2018; 25:501-511. [PMID: 29168099 PMCID: PMC5758679 DOI: 10.1245/s10434-017-6257-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Nine breast cancer quality measures (QM) were selected by the American Society of Breast Surgeons (ASBrS) for the Centers for Medicare and Medicaid Services (CMS) Quality Payment Programs (QPP) and other performance improvement programs. We report member performance. STUDY DESIGN Surgeons entered QM data into an electronic registry. For each QM, aggregate "performance met" (PM) was reported (median, range and percentiles) and benchmarks (target goals) were calculated by CMS methodology, specifically, the Achievable Benchmark of Care™ (ABC) method. RESULTS A total of 1,286,011 QM encounters were captured from 2011-2015. For 7 QM, first and last PM rates were as follows: (1) needle biopsy (95.8, 98.5%), (2) specimen imaging (97.9, 98.8%), (3) specimen orientation (98.5, 98.3%), (4) sentinel node use (95.1, 93.4%), (5) antibiotic selection (98.0, 99.4%), (6) antibiotic duration (99.0, 99.8%), and (7) no surgical site infection (98.8, 98.9%); all p values < 0.001 for trends. Variability and reasons for noncompliance by surgeon for each QM were identified. The CMS-calculated target goals (ABC™ benchmarks) for PM for 6 QM were 100%, suggesting that not meeting performance is a "never should occur" event. CONCLUSIONS Surgeons self-reported a large number of specialty-specific patient-measure encounters into a registry for self-assessment and participation in QPP. Despite high levels of performance demonstrated initially in 2011 with minimal subsequent change, the ASBrS concluded "perfect" performance was not a realistic goal for QPP. Thus, after review of our normative performance data, the ASBrS recommended different benchmarks than CMS for each QM.
Collapse
Affiliation(s)
| | | | - Lisa Bailey
- Bay Area Breast Surgeons, Inc, Oakland, CA, USA
| | | | | | | | | | | | | | | | - Caprice Greenberg
- University of Wisconsin School of Public Health and Medicine, Madison, WI, USA
| | | | | | | | | | | | - Lee Wilke
- University of Wisconsin School of Public Health and Medicine, Madison, WI, USA
| | - Roshni Rao
- Columbia University Medical Center, New York, NY, USA
| |
Collapse
|
19
|
van Dam P, Tomatis M, Marotti L, Heil J, Mansel R, Rosselli del Turco M, van Dam P, Casella D, Bassani L, Danei M, Denk A, Egle D, Emons G, Friedrichs K, Harbeck N, Kiechle M, Kimmig R, Koehler U, Kuemmel S, Maass N, Mayr C, Prové A, Rageth C, Regolo L, Lorenz-Salehi F, Sarlos D, Singer C, Sohn C, Staelens G, Tinterri C, Audisio R, Ponti A, Badbanchi F, Catalano G, Cretella E, Daniaux M, Emons A, van Eygen K, Ettl J, Gatzemeier W, Kern P, Schneeweiss A, Stoeblen F, Van As A, Wuerstlein R, Zanini V. Time trends (2006–2015) of quality indicators in EUSOMA-certified breast centres. Eur J Cancer 2017; 85:15-22. [DOI: 10.1016/j.ejca.2017.07.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 05/31/2017] [Accepted: 07/25/2017] [Indexed: 12/21/2022]
|
20
|
Biganzoli L, Marotti L, Hart CD, Cataliotti L, Cutuli B, Kühn T, Mansel RE, Ponti A, Poortmans P, Regitnig P, van der Hage JA, Wengström Y, Rosselli Del Turco M. Quality indicators in breast cancer care: An update from the EUSOMA working group. Eur J Cancer 2017; 86:59-81. [DOI: 10.1016/j.ejca.2017.08.017] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/07/2017] [Accepted: 08/11/2017] [Indexed: 02/07/2023]
|
21
|
Powis M, Sutradhar R, Gonzalez A, Enright KA, Taback NA, Booth CM, Trudeau M, Krzyzanowska MK. Establishing achievable benchmarks for quality improvement in systemic therapy for early-stage breast cancer. Cancer 2017; 123:3772-3780. [PMID: 28678343 DOI: 10.1002/cncr.30804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 02/14/2017] [Accepted: 05/09/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Setting realistic targets for performance is a consistent challenge in quality improvement. In the current study, the authors used administrative data to define achievable targets for a panel of 15 previously developed quality indicators (QIs) focusing on systemic therapy in patients with early-stage breast cancer. METHODS Deterministically linked administrative databases were used to identify patients with TNM stage I to stage III breast cancer who were diagnosed between 2006 and 2010 in Ontario, Canada. For each individual indicator, data-driven empirical benchmarks were calculated using the pared-mean benchmark approach. Variation in institution-level performance for each indicator was examined through the construction of funnel plots. RESULTS A total of 28,303 patients with early-stage breast cancer were identified, 43% of whom received adjuvant chemotherapy. For the 9 QIs for which receiving the service or outcome was desirable (ie, consultation with a medical oncologist), the benchmark varied from 40.9% to 100%. For the 6 indicators for which not receiving the service or outcome was desirable (ie, incidence of febrile neutropenia), the benchmark varied from 0% to 49.0%. There was substantial variation noted with regard to the number of institutions meeting the target and the amount of interinstitution variation between the QIs. Top performing institutions varied by indicator, with no individual institution meeting the benchmark for all indicators. For the majority of indicators, institution size was not found to be correlated with performance. CONCLUSIONS Data-derived benchmarking can be used to facilitate quality improvement by identifying areas of both good as well as suboptimal performance while defining an achievable target for which to strive. Cancer 2017;123:3772-3780. © 2017 American Cancer Society.
Collapse
Affiliation(s)
- Melanie Powis
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Katherine A Enright
- Trillium Health Partners, Mississauga, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nathan A Taback
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | - Maureen Trudeau
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Odette Cancer Centre, Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
22
|
Massa I, Balzi W, Burattini C, Gentili N, Bucchi L, Nanni O, Gallegati D, Pierini A, Amadori D, Falcini F, Altini M. The challenge of sustainability in healthcare systems: Frequency and cost of inappropriate patterns of breast cancer care (the E.Pic.A study). Breast 2017; 34:103-107. [PMID: 28558338 DOI: 10.1016/j.breast.2017.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/03/2017] [Accepted: 05/15/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES In a context of decreasing economic health resources and a rise in health needs, it is urgent to face this sustainability crisis through the analysis of healthcare expenditures. Wastages, deriving from inappropriate interventions, erode resources which could be reallocated to high-value activities. To identify these areas of wastages, we developed a method for combining and analyzing data from multiple sources. Here we report the preliminary results of a retrospective cohort study evaluating the performance of breast cancer (BC) care at IRST, an Italian cancer institute. MATERIALS AND METHODS Four data sources gathered in a real-world setting (a clinical database, two administrative databases and a cancer registry) were linked. Essential Key Performance Indexes (KPIs) in the pattern of BC diagnosis (KPI 1 and 2) and treatment (KPI 3 and 4) based on current guidelines were developed by a board of professionals. The costs of inappropriate examinations were associated with the diagnostic KPIs. RESULTS We found that 2798 patients treated at IRST from January 2010 to June 2016 received a total of 2516 inappropriate examinations accounting for € 573,510.80. Linkage from multiple routine healthcare data sources is feasible: it allows the measurement of important KPIs specifically designed for BC care, and the identification of areas of low-value use of the resources. CONCLUSION If systematically applied, this method could help provide a complete picture of inappropriateness and waste, redirect these resources to higher-value interventions for patients, and fill the gap between proper use of the resources and the best clinical results.
Collapse
Affiliation(s)
- Ilaria Massa
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli 40, 47014 Meldola, FC, Italy.
| | - William Balzi
- Healthcare Administration, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli 40, 47014 Meldola, FC, Italy.
| | - Costanza Burattini
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli 40, 47014 Meldola, FC, Italy.
| | - Nicola Gentili
- IT Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli 40, 47014 Meldola, FC, Italy.
| | - Lauro Bucchi
- Romagna Tumor Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli 40, 47014 Meldola, FC, Italy.
| | - Oriana Nanni
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli 40, 47014 Meldola, FC, Italy.
| | - Davide Gallegati
- Management and Accounting Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli 40, 47014 Meldola, FC, Italy.
| | - Andrea Pierini
- Market Access, Roche S.p.A., via G.B. Stucchi 110, 20900 Monza, MB, Italy.
| | - Dino Amadori
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli 40, 47014 Meldola, FC, Italy.
| | - Fabio Falcini
- Romagna Tumor Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli 40, 47014 Meldola, FC, Italy; Azienda USL della Romagna, Forlí, Italy.
| | - Mattia Altini
- Healthcare Administration, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, via P. Maroncelli 40, 47014 Meldola, FC, Italy.
| |
Collapse
|
23
|
Héquet D, Huchon C, Baffert S, Alran S, Reyal F, Nguyen T, Combes A, Trichot C, Alves K, Berseneff H, Rouzier R. Preoperative clinical pathway of breast cancer patients: determinants of compliance with EUSOMA quality indicators. Br J Cancer 2017; 116:1394-1401. [PMID: 28441385 PMCID: PMC5520093 DOI: 10.1038/bjc.2017.114] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 12/23/2022] Open
Abstract
Background: The European Society of Breast Cancer Specialists (EUSOMA) has defined quality indicators for breast cancer (BC). The aim of this study was to describe the preoperative clinical pathway of breast cancer patients and evaluate the determinants of compliance with EUSOMA quality indicators in the Optisoins01 cohort. Methods: Optisoins01 is a prospective, multicentric study. Data from operable BC patients were collected, including results from before surgery to 1 year follow-up. Seven preoperative EUSOMA quality indicators were compared with the clinical pathways Optisoins01. Results: Six hundred and four patients were included. European Society of Breast Cancer Specialists targets were reached for indicator 1 (completeness of clinical and imaging diagnostic work-up), 3 (preoperative definitive diagnosis) and 5 (waiting time). For indicator 8 (multidisciplinary discussion), the minimum standard of 90% of the patients was reached only in general hospitals and comprehensive cancer centres. Having more than 1 medical examination within the centre was associated with an increased waiting time for surgery, whereas it was reduced by having an outpatient breast biopsy. The comprehensive cancer centre type was the only parameter associated with the other quality indicators. Conclusions: European Society of Breast Cancer Specialists quality indicators are a useful tool to evaluate care organisations. This study highlights the need for a standardised and coordinated preoperative clinical pathway.
Collapse
Affiliation(s)
- Delphine Héquet
- Department of Surgical Oncology, Institut Curie-Centre René Huguenin, 35 Rue Dailly, 92210 Saint-Cloud, France.,Equipe d'Accueil 7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, University Versailles-Saint-Quentin, 2 av de la source de la Bièvre, 78180 Montigny-le-Bretonneux, France.,School of Oncology, Paris-Sud University, ED418 Paris, France
| | - Cyrille Huchon
- Equipe d'Accueil 7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, University Versailles-Saint-Quentin, 2 av de la source de la Bièvre, 78180 Montigny-le-Bretonneux, France.,Department of Obstetrics and Gynecology, Hôpital de Poissy-St Germain, 10 Rue du Champ Gaillard, 78300 Poissy, France
| | - Sandrine Baffert
- Center of studies and innovations in health, Fondation A. de Rothschild, 25 rue Manin, 75940 Paris, France
| | - Séverine Alran
- Department of Surgical Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France
| | - Fabien Reyal
- Department of Surgical Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France.,Residual Tumor and Response to Treatment Lab, Translational Research Department, Institut Curie, 75005, Paris, France.,UMR932 Immunity and Cancer, INSERM, Institut Curie, 75005 Paris, France
| | - Thuy Nguyen
- Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, 178 Rue des Renouillers, 92701 Colombes, France
| | - Alix Combes
- Department of Obstetrics and Gynecology, Hôpital André Mignot, 177 Rue de Versailles, 78150 Le Chesnay, France
| | - Caroline Trichot
- Department of Obstetrics and Gynecology, Assistance Publique-Hôpitaux de Paris, Hôpital Antoine Béclère, 157 Rue de la Porte de Trivaux, 92140 Clamart, France
| | - Karine Alves
- Department of Obstetrics and Gynecology, Hôpital Victor Dupouy, 95107 Argenteuil, France
| | - Hélène Berseneff
- Department of Obstetrics and Gynecology, Hôpital René Dubos, 6 Avenue de l'Île de France, 95300, Pontoise, France
| | - Roman Rouzier
- Department of Surgical Oncology, Institut Curie-Centre René Huguenin, 35 Rue Dailly, 92210 Saint-Cloud, France.,Equipe d'Accueil 7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, University Versailles-Saint-Quentin, 2 av de la source de la Bièvre, 78180 Montigny-le-Bretonneux, France
| |
Collapse
|
24
|
Cardoso F, Cataliotti L, Costa A, Knox S, Marotti L, Rutgers E, Beishon M. European Breast Cancer Conference manifesto on breast centres/units. Eur J Cancer 2017; 72:244-250. [PMID: 28064097 DOI: 10.1016/j.ejca.2016.10.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022]
Abstract
MANIFESTO-CALL TO ACTION.
Collapse
Affiliation(s)
- Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center, Lisbon, Portugal.
| | - Luigi Cataliotti
- Breast Centres Certification and Senonetwork Italia Onlus, Italy
| | | | - Susan Knox
- Europa Donna - The European Breast Cancer Coalition, Milan, Italy
| | - Lorenza Marotti
- EUSOMA - European Society of Breast Cancer Specialists, Italy
| | - Emiel Rutgers
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | |
Collapse
|
25
|
Mauri G, Sconfienza LM, Pescatori LC, Fedeli MP, Alì M, Di Leo G, Sardanelli F. Technical success, technique efficacy and complications of minimally-invasive imaging-guided percutaneous ablation procedures of breast cancer: A systematic review and meta-analysis. Eur Radiol 2017; 27:3199-3210. [PMID: 28050693 DOI: 10.1007/s00330-016-4668-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 11/13/2016] [Accepted: 11/17/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To systematically review studies concerning imaging-guided minimally-invasive breast cancer treatments. METHODS An online database search was performed for English-language articles evaluating percutaneous breast cancer ablation. Pooled data and 95% confidence intervals (CIs) were calculated. Technical success, technique efficacy, minor and major complications were analysed, including ablation technique subgroup analysis and effect of tumour size on outcome. RESULTS Forty-five studies were analysed, including 1,156 patients and 1,168 lesions. Radiofrequency (n=577; 50%), microwaves (n=78; 7%), laser (n=227; 19%), cryoablation (n=156; 13%) and high-intensity focused ultrasound (HIFU, n=129; 11%) were used. Pooled technical success was 96% (95%CI 94-97%) [laser=98% (95-99%); HIFU=96% (90-98%); radiofrequency=96% (93-97%); cryoablation=95% (90-98%); microwave=93% (81-98%)]. Pooled technique efficacy was 75% (67-81%) [radiofrequency=82% (74-88); cryoablation=75% (51-90); laser=59% (35-79); HIFU=49% (26-74)]. Major complications pooled rate was 6% (4-8). Minor complications pooled rate was 8% (5-13%). Differences between techniques were not significant for technical success (p=0.449), major complications (p=0.181) or minor complications (p=0.762), but significant for technique efficacy (p=0.009). Tumour size did not impact on variables (p>0.142). CONCLUSIONS Imaging-guided percutaneous ablation techniques of breast cancer have a high rate of technical success, while technique efficacy remains suboptimal. Complication rates are relatively low. KEY POINTS • Imaging-guided ablation techniques for breast cancer are 96% technically successful. • Overall technique efficacy rate is 75% but largely inhomogeneous among studies. • Overall major and minor complication rates are low (6-8%).
Collapse
Affiliation(s)
- Giovanni Mauri
- Dipartimento di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Ripamonti 435, 20100, Milano, Italy.
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100, Milano, Italy.,Unità Operativa di Radiologia / Diagnostica per Immagini con Servizio di Radiologia Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milano, Italy
| | - Lorenzo Carlo Pescatori
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy
| | - Maria Paola Fedeli
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milano, Italy
| | - Marco Alì
- Integrative Biomedical Research PhD Program, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milano, Italy
| | - Giovanni Di Leo
- Unità di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20100, Milano, Italy.,Unità di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Italy
| |
Collapse
|