Olga Kantor1, Chi-Hsiung Wang2,3, Katharine Yao4,5. 1. Department of Surgery, University of Chicago, Chicago, IL, USA. 2. Division of Surgical Oncology, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. 3. Biostatistical Core, NorthShore University HealthSystem Research Institute, Evanston, IL, USA. 4. Division of Surgical Oncology, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. kyao@northshore.org. 5. Pritzker School of Medicine, University of Chicago, Chicago, IL, USA. kyao@northshore.org.
Abstract
BACKGROUND: Adherence to quality measures has become an important indicator of cancer center performance for high-quality cancer care. We examined regional variation in performance for Commission on Cancer breast quality measures and its impact on overall survival (OS) for those measures that have been shown to impact OS. METHODS: Six breast quality measures were analyzed using the National Cancer Data Base from 2014 to 2015, and a multivariable model was used to assess performance for each measure by region. Kaplan-Meier and Cox proportional hazard models were used to examine OS between high- and low-performing centers from 2007 to 2012. RESULTS: Overall, 305,391 women had surgery at 1322 institutions in nine US regions; 90.8% underwent needle biopsy (range 86.0-92.6% between regions, p < 0.01), 69.8% had breast-conserving surgery (BCS) for stage 0-II cancer (60.9-79.3%, p < 0.01), 85.2% aged < 70 years had radiation therapy (RT) after BCS (79.6-90.8%, p < 0.01), 78.3% of women with four or more positive nodes had post-mastectomy RT (70.9-84.5%, p < 0.01), 90.9% with hormone receptor (HR)-positive stage IB-III cancer had hormone therapy (83.7-95.1%, p < 0.01), and 89.4% aged < 70 years with HR-negative stage IB-III cancer had chemotherapy (87.6-91.4%, p < 0.01). Multivariate analyses adjusted for patient and facility factors found that region was the only consistent predictor of non-compliance across measures. With median 65-month follow-up, there was no difference in OS between high- and low-performing centers for the three measures that have been shown to impact OS. CONCLUSIONS: There is significant regional variation in performance on the breast quality measures but this variation did not impact OS. Targeted efforts in certain areas of the country may help improve performance on these measures.
BACKGROUND: Adherence to quality measures has become an important indicator of cancer center performance for high-quality cancer care. We examined regional variation in performance for Commission on Cancer breast quality measures and its impact on overall survival (OS) for those measures that have been shown to impact OS. METHODS: Six breast quality measures were analyzed using the National Cancer Data Base from 2014 to 2015, and a multivariable model was used to assess performance for each measure by region. Kaplan-Meier and Cox proportional hazard models were used to examine OS between high- and low-performing centers from 2007 to 2012. RESULTS: Overall, 305,391 women had surgery at 1322 institutions in nine US regions; 90.8% underwent needle biopsy (range 86.0-92.6% between regions, p < 0.01), 69.8% had breast-conserving surgery (BCS) for stage 0-II cancer (60.9-79.3%, p < 0.01), 85.2% aged < 70 years had radiation therapy (RT) after BCS (79.6-90.8%, p < 0.01), 78.3% of women with four or more positive nodes had post-mastectomy RT (70.9-84.5%, p < 0.01), 90.9% with hormone receptor (HR)-positive stage IB-III cancer had hormone therapy (83.7-95.1%, p < 0.01), and 89.4% aged < 70 years with HR-negative stage IB-III cancer had chemotherapy (87.6-91.4%, p < 0.01). Multivariate analyses adjusted for patient and facility factors found that region was the only consistent predictor of non-compliance across measures. With median 65-month follow-up, there was no difference in OS between high- and low-performing centers for the three measures that have been shown to impact OS. CONCLUSIONS: There is significant regional variation in performance on the breast quality measures but this variation did not impact OS. Targeted efforts in certain areas of the country may help improve performance on these measures.
Authors: Tina W F Yen; Zhuping Garacci; Purushottam W Laud; Liliana E Pezzin; Ann B Nattinger Journal: Breast Cancer Date: 2021-01-04 Impact factor: 4.239
Authors: Sarah R Kaslow; Leena Hani; Greg D Sacks; Ann Y Lee; Russell S Berman; Camilo Correa-Gallego Journal: Ann Surg Oncol Date: 2022-09-19 Impact factor: 4.339
Authors: Daniel S O'Neil; Wenlong Carl Chen; Oluwatosin Ayeni; Sarah Nietz; Ines Buccimazza; Urishka Singh; Sharon Čačala; Laura Stopforth; Maureen Joffe; Katherine D Crew; Judith S Jacobson; Alfred I Neugut; Paul Ruff; Herbert Cubasch Journal: J Glob Oncol Date: 2019-11