Skip to main content

Advertisement

SpringerLink
Log in

National Evaluation of Hospital Performance on the New Commission on Cancer Melanoma Quality Measures

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

To increase adherence to cancer management guidelines, the Commission on Cancer (CoC) developed and approved five melanoma quality measures in 2015. Our objectives were to evaluate formally the national performance of these melanoma measures and to examine patient, tumor, and hospital characteristics associated with adherence.

Methods

From the National Cancer Data Base (2012), patients with invasive, nonmetastatic melanoma were identified. Inclusion and exclusion criteria were based on the CoC definition for each measure. Patient-level and hospital-level adherence rates were calculated for the five measures. A hospital was deemed “compliant” if it met the CoC standard, which requires 80 % of patients to receive the measure-specific recommended care. Patient, tumor, and hospital characteristics potentially associated with higher likelihood of adherence at the patient-level were estimated using hierarchical random-effects logistic regression models.

Results

A total of 31,598 patients from 1343 hospitals were examined. Patient-level adherence rates varied from 31.6 % (Measure 5: ≥10 axillary lymph nodes removed/examined) to 72.6 % (Measure 1: sentinel lymph node biopsy (SLNB) appropriateness measure). Hospital-level adherence rates, ranged from 19.3 % of hospitals (N = 538 hospitals for Measure 5) to 44.8 % of hospitals (N = 1090 hospitals for Measure 3: completion lymph node dissection after positive SLNB). No hospital-level factors (e.g., teaching status) were consistently associated with better adherence.

Conclusions

National adherence rates to the five new CoC melanoma quality metrics are low, and most hospitals would not meet the CoC requirement of 80 % adherence. Feedback for performance of these measures to hospitals, decisions support tools, and educational initiatives are needed to improve guideline adherence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bilimoria KY, Raval MV, Bentrem DJ, Wayne JD, Balch CM, Ko CY. National assessment of melanoma care using formally developed quality indicators. J Clin Oncol. 2009;27(32):5445–51.

    Article  PubMed  Google Scholar 

  2. Bilimoria KY, Bentrem DJ, Feinglass JM, et al. Directing surgical quality improvement initiatives: comparison of perioperative mortality and long-term survival for cancer surgery. J Clin Oncol. 2008;26(28):4626–33.

    Article  PubMed  Google Scholar 

  3. Bilimoria KY, Balch CM, Bentrem DJ, et al. Complete lymph node dissection for sentinel node-positive melanoma: assessment of practice patterns in the United States. Ann Surg Oncol. 2008;15(6):1566–76.

    Article  PubMed  Google Scholar 

  4. Gogas HJ, Kirkwood JM, Sondak VK. Chemotherapy for metastatic melanoma: time for a change? Cancer. 2007;109(3):455–64.

    Article  CAS  PubMed  Google Scholar 

  5. El-Maraghi RH, Kielar AZ. PET vs sentinel lymph node biopsy for staging melanoma: a patient intervention, comparison, outcome analysis. J Am Coll Radiol. 2008;5(8):924–31.

    Article  PubMed  Google Scholar 

  6. Jones C, Zhao Z, Barber B, Bagijn M, Corrie P, Saltman D. Treatment patterns in advanced melanoma: findings from a survey of European oncologists. Eur J Cancer Care. 2015;24(6):862–6.

    Article  CAS  Google Scholar 

  7. Bartlett EK, Simmons KD, Wachtel H, et al. The rise in metastasectomy across cancer types over the past decade. Cancer. 2015;121(5):747–57.

    Article  PubMed  Google Scholar 

  8. CoC measures for quality of cancer care. https://www.facs.org/quality-programs/cancer/ncdb/qualitymeasures. Accessed 15 June 2015.

  9. Bilimoria KY, Stewart AK, Winchester DP, Ko CY. The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol. 2008;15(3):683–90.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27(36):6199–206.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kester BS, Wayne JD, Ross MI, Bentrem DJ, Merkow RP, Bilimoria KY. An opportunity to ensure high-quality melanoma care through the use of a preoperative treatment algorithm. Ann Surg Oncol. 2013;20(12):3976–83.

    Article  PubMed  Google Scholar 

  12. Lee JH, Essner R, Torisu-Itakura H, Wanek L, Wang H, Morton DL. Factors predictive of tumor-positive nonsentinel lymph nodes after tumor-positive sentinel lymph node dissection for melanoma. J Clin Oncol. 2004;22(18):3677–84.

    Article  PubMed  Google Scholar 

  13. Agnese DM, Abdessalam SF, Burak Jr WE, Magro CM, Pozderac RV, Walker MJ. Cost-effectiveness of sentinel lymph node biopsy in thin melanomas. Surgery. 2003;134(4):542–7; discussion 547–8.

  14. Bleicher RJ, Essner R, Foshag LJ, Wanek LA, Morton DL. Role of sentinel lymphadenectomy in thin invasive cutaneous melanomas. J Clin Oncol. 2003;21(7):1326–31.

    Article  PubMed  Google Scholar 

  15. Cecchi R, Buralli L, Innocenti S, De Gaudio C. Sentinel lymph node biopsy in patients with thin melanomas. J Dermatol. 2007;34(8):512–5.

    Article  PubMed  Google Scholar 

  16. Wong SL, Brady MS, Busam KJ, Coit DG. Results of sentinel lymph node biopsy in patients with thin melanoma. Ann Surg Oncol. 2006;13(3):302–9.

    Article  PubMed  Google Scholar 

  17. Balch CM, Buzaid AC, Soong SJ, et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol. 2001;19(16):3635–48.

    CAS  PubMed  Google Scholar 

  18. Mitteldorf C, Bertsch HP, Jung K, et al. Sentinel node biopsy improves prognostic stratification in patients with thin (pT1) melanomas and an additional risk factor. Ann Surg Oncol. 2014;21(7):2252–8.

    Article  PubMed  Google Scholar 

  19. Yonick DV, Ballo RM, Kahn E, et al. Predictors of positive sentinel lymph node in thin melanoma. Am J Surg. 2011;201(3):324–7; discussion 327–8.

  20. Wong SL, Balch CM, Hurley P, et al. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. J Clin Oncol. 2012;30(23):2912–8.

    Article  PubMed  Google Scholar 

  21. Francken AB, Shaw HM, Thompson JF, et al. The prognostic importance of tumor mitotic rate confirmed in 1317 patients with primary cutaneous melanoma and long follow-up. Ann Surg Oncol. 2004;11(4):426–33.

    Article  PubMed  Google Scholar 

  22. Thompson JF, Soong SJ, Balch CM, et al. Prognostic significance of mitotic rate in localized primary cutaneous melanoma: an analysis of patients in the multi-institutional American Joint Committee on Cancer melanoma staging database. J Clin Oncol. 2011;29(16):2199–205.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kretschmer L, Starz H, Thoms KM, et al. Age as a key factor influencing metastasizing patterns and disease-specific survival after sentinel lymph node biopsy for cutaneous melanoma. Int J Cancer. 2011;129(6):1435–42.

    Article  CAS  PubMed  Google Scholar 

  24. Morton DL, Thompson JF, Cochran AJ, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014;370(7):599–609.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Melanoma. NCCN clinical practice guidelines in oncology 2015. http://www.nccn.org/professionals/physician_gls/pdf/melanoma.pdf. Accessed 30 June 2015.

  26. Bilimoria KY, Balch CM, Wayne JD, et al. Health care system and socioeconomic factors associated with variance in use of sentinel lymph node biopsy for melanoma in the United States. J Clin Oncol. 2009;27(11):1857–63.

    Article  PubMed  Google Scholar 

  27. Cascinelli N, Bombardieri E, Bufalino R, et al. Sentinel and nonsentinel node status in stage IB and II melanoma patients: two-step prognostic indicators of survival. J Clin Oncol. 2006;24(27):4464–71.

    Article  PubMed  Google Scholar 

  28. Nagaraja V, Eslick GD. Is complete lymph node dissection after a positive sentinel lymph node biopsy for cutaneous melanoma always necessary? A meta-analysis. Eur J Surg Oncol. 2013;39(7):669–80.

    Article  CAS  PubMed  Google Scholar 

  29. de Vries M, Vonkeman WG, van Ginkel RJ, Hoekstra HJ. Morbidity after inguinal sentinel lymph node biopsy and completion lymph node dissection in patients with cutaneous melanoma. Eur J Surg Oncol. 2006;32(7):785–9.

    Article  PubMed  Google Scholar 

  30. Colon cancer. NCCN clinical practice guidelines in oncology 2015. http://www.nccn.org/professionals/physician_gls/pdf/colon.pdf. Accessed 16 July 2015.

  31. Gastric cancer. NCCN clinical practice guidelines in oncology 2015. http://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf. Accessed 6 Aug 2015.

  32. Xing Y, Badgwell BD, Ross MI, et al. Lymph node ratio predicts disease-specific survival in melanoma patients. Cancer. 2009;115(11):2505–13.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Spillane AJ, Cheung BL, Stretch JR, et al. Proposed quality standards for regional lymph node dissections in patients with melanoma. Ann Surg. 2009;249(3):473–80.

    Article  PubMed  Google Scholar 

  34. Bilimoria KY, Bentrem DJ, Stewart AK, Winchester DP, Ko CY. Comparison of Commission on Cancer-approved and -nonapproved hospitals in the United States: implications for studies that use the National Cancer Data Base. J Clin Oncol. 2009;27(25):4177–81.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This study is supported by the Northwestern Institute for Comparative Effectiveness Research NICER in Oncology (NICER Onc) of the Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University. Dr. Minami is Postdoctoral Fellow under an Institutional Award from the AHRQ, T-32 HS 000078. Dr. Martini has received Honoraria from, has had a consulting or advisory role for, and has received travel and accommodation expenses reimbursed by Unilever. Dr. Gerami has received Honoraria from and been paid for a consulting role to Dermtech, Inc., Castle Biosciences, and Myrian Genetics.

Conflicts of Interest

The other authors have no financial disclosures or conflicts of interest.

Author information

Authors and Affiliations

  1. Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Christina A. Minami MD, Anthony D. Yang MD & Karl Y. Bilimoria MD

  2. Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Christina A. Minami MD, Anthony D. Yang MD & Karl Y. Bilimoria MD

  3. Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Christina A. Minami MD & Karl Y. Bilimoria MD

  4. Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Jeffrey D. Wayne MD, Anthony D. Yang MD & Karl Y. Bilimoria MD

  5. Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Mary C. Martini MD & Pedram Gerami MD

  6. Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Pedram Gerami MD

  7. Division of Hematology/Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Sunandana Chandra MD & Timothy M. Kuzel MD

  8. National Cancer Data Base, American College of Surgeons, Chicago, IL, USA

    David P. Winchester MD & Bryan E. Palis PhD

Authors
  1. Christina A. Minami MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeffrey D. Wayne MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anthony D. Yang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mary C. Martini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pedram Gerami MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sunandana Chandra MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Timothy M. Kuzel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. David P. Winchester MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bryan E. Palis PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Karl Y. Bilimoria MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karl Y. Bilimoria MD.

Appendix

Appendix

See Table 4.

Table 4 Baseline characteristic of patients eligible for CoC quality measures
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Minami, C.A., Wayne, J.D., Yang, A.D. et al. National Evaluation of Hospital Performance on the New Commission on Cancer Melanoma Quality Measures. Ann Surg Oncol 23, 3548–3557 (2016). https://doi.org/10.1245/s10434-016-5302-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-016-5302-4

Keywords

Search

Navigation