Healthcare Policy and Outcomes

Annals of Surgical Oncology

, Volume 17, Issue 8, pp 1989-1994

First online:

Adherence to the National Quality Forum (NQF) Breast Cancer Measures Within Cancer Clinical Trials: A Review From ACOSOG Z0010

  • Lee G. WilkeAffiliated withDepartment of Surgery, Duke University Medical Center Email author 
  • , Karla V. BallmanAffiliated withDivision of Biomedical Statistics and Informatics, Mayo Clinic
  • , Linda M. McCallAffiliated withDivision of Biomedical Statistics and Informatics, Mayo Clinic
  • , Armando E. GiulianoAffiliated withJohn Wayne Cancer Institute Breast Center
  • , Pat W. WhitworthAffiliated withNashville Breast Center, Vanderbilt University
  • , Peter W. BlumencranzAffiliated withMoffitt Morton Plant Cancer Center
  • , Douglas S. ReintgenAffiliated withLakeland Regional Cancer Center
  • , William E. BurakAffiliated withDepartment of Surgery, Ohio State University
  • , A. Marilyn LeitchAffiliated withDepartment of Surgery, Southwestern Medical Center, University of Texas
    • , Kelly K. HuntAffiliated withDepartment of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center

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In 2007, the National Quality Forum (NQF) released four performance measures for the treatment of breast cancer. We proposed to study the degree of adherence with these measures among participating institutions in a multi-institutional trial.


American College of Surgeons Oncology Group (ACOSOG) Z0010 enrolled breast cancer patients onto a phase II trial studying the prognostic significance of bone marrow and sentinel node micrometastases. The current study used χ2 analyses to determine the degree of adherence with four NQF measures among three institution types: academic, community, and teaching affiliate.


The study revealed small but important differences in two measures. Ninety-five percent of patients from teaching affiliated institutions received whole-breast radiation compared to 92% at academic and 91% at community hospitals. Among patients who were underinsured or uninsured, a marked decrease in radiation use was noted in comparison to patients with insurance—85 versus 93%, respectively. The study also revealed a difference among institutional types in patients undergoing excisional biopsy for diagnosis. In teaching-affiliated hospitals, 28.6% underwent excisional biopsy as compared to 36.8 and 37.4% in academic and community hospitals, respectively. There was no statistically significant difference between adherence rates with the remaining two measures. Adjuvant chemotherapy was administered to patients with hormone receptor negative tumors ≥1 cm in size in 79–85% of institutions. Tamoxifen was administered to 79–82% of those patients with hormone receptor–positive cancers.


Among breast cancer patients enrolled onto a multi-institutional clinical trial, we found a high degree of adherence with current consensus standards for adjuvant treatment, despite varied practice environments.