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Annals of Surgical Oncology

, Volume 22, Supplement 3, pp 522–528 | Cite as

The Value of Ipsilateral Breast Tumor Recurrence as a Quality Indicator: Hospital Variation in the Netherlands

  • M. van der Heiden-van der LooEmail author
  • S. Siesling
  • M. W. J. M. Wouters
  • T. van Dalen
  • E. J. T. Rutgers
  • P. H. M. Peeters
Breast Oncology

Abstract

Purpose

All Dutch hospitals are obliged to report their 5-year ipsilateral breast tumor recurrence (IBTR) rate after breast cancer surgery. Experts decided that these rates should not exceed 5 %. This study determined the value of IBTR as an indicator to compare quality of care between hospitals.

Methods

All patients with breast cancer (pT1–3, any N, M0) who underwent surgery in 1 of 92 Dutch hospitals from 2003 to 2006 were identified in the Netherlands Cancer Registry. Data of recurrence was retrieved from hospital records. Five-year IBTR rates for breast-conserving surgery (BCS) and mastectomy were calculated by using the Kaplan–Meier method. Hospital variation was presented in funnel plots. Multivariate analysis was used to assess hospital characteristics associated with IBTR rates.

Results

A total of 40,892 breast cancer patients were included. The overall 5-year IBTR rate was 2.85 % (95 % confidence interval 2.68–3.03) and was significantly lower for BCS than for mastectomy (2.38 vs. 3.45 %, p < 0.001). IBTR rates decreased over time in both groups. Rates varied between 0.77 and 5.70 % between hospitals. When random variation is taken into account, only extremely high IBTR rates can be detected as deviant from the target value of 5 %. Adjusting for tumor and patient characteristics, analyses showed that a higher volume of mastectomies is associated with lower IBTR rates.

Conclusions

Our population-based findings show that IBTR rates in the Netherlands are low and have improved over time. The 5-year IBTR rate as an indicator for quality of care of individual hospitals is of limited value.

Keywords

Breast Cancer Hospital Volume Ipsilateral Breast Tumor Recurrence Dutch Hospital Final Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Birkmeyer JD, Dimick JB, Birkmeyer NJ. Measuring the quality of surgical care: structure, process, or outcomes? J Am Coll Surg. 2004;198(4):626–32.PubMedCrossRefGoogle Scholar
  2. 2.
    Donabedian A: Evaluating the quality of medical care. Milbank Q. 1966;83(4):691–729.CrossRefGoogle Scholar
  3. 3.
    Rubin HR, Pronovost P, Diette GB. From a process of care to a measure: the development and testing of a quality indicator. Int J Qual Health Care. 2001;13(6):489–96.PubMedCrossRefGoogle Scholar
  4. 4.
    Brien SE, Dixon E, Ghali WA. Measuring and reporting on quality in health care: a framework and road map for improving care. J Surg Oncol. 2009;99(8):462–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Del Turco MR, Ponti A, Bick U, Biganzoli L, Cserni G, Cutuli B, Decker T, Dietel M, Gentilini O, Kuehn T, et al. Quality indicators in breast cancer care. Eur J Cancer. 2010;46(13):2344–56.PubMedCrossRefGoogle Scholar
  6. 6.
    Rutgers EJ, Wittenberg J, Kuijpers AC. Kwaliteit van zorg rond mammacarcinoom in de etalage. In: Utrecht: CBO, Orde van Medisch Specialisten; 2006.Google Scholar
  7. 7.
    Rutgers EJ, Group EC. Quality control in the locoregional treatment of breast cancer. Eur J Cancer. 2001;37(4):447–53.PubMedCrossRefGoogle Scholar
  8. 8.
    van der Heiden-van der Loo M, Ho VK, Damhuis RA, Siesling S, Menke MB, Peeters PH, Rutgers EJ: Percentage of local recurrence following treatment for breast cancer is not a suitable performance indicator. Nederlands Tijdschrift Geneeskunde. 2010;154:A1984.Google Scholar
  9. 9.
    Schouten LJ, Hoppener P, van den Brandt PA, Knottnerus JA, Jager JJ. Completeness of cancer registration in Limburg, The Netherlands. Int J Epidemiol. 1993;22(3):369–76.PubMedCrossRefGoogle Scholar
  10. 10.
    Sobin LH, Wittekind C. TNM Classification of malignant tumours. International Union against cancer (UICC), vol. 6. New York: Wiley-Liss; 2002.Google Scholar
  11. 11.
    Moossdorff M, van Roozendaal LM, Strobbe LJ, Aebi S, Cameron DA, Dixon JM, Giuliano AE, Haffty BG, Hickey BE, Hudis CA, et al. Maastricht delphi consensus on event definitions for classification of recurrence in breast cancer research. J Natl Cancer Inst. 2014;106(12):dju288.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Spiegelhalter DJ. Funnel plots for comparing institutional performance. Stat Med. 2005;24(8):1185–202.PubMedCrossRefGoogle Scholar
  13. 13.
    Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, Godwin J, Gray R, Hicks C, James S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366(9503):2087–106.PubMedCrossRefGoogle Scholar
  14. 14.
    Early Breast Cancer Trialists’ Collaborative G, Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, Cutter D, Davies C, Ewertz M, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378(9804):1707–16.CrossRefGoogle Scholar
  15. 15.
    Kolfschoten NE, Marang van de Mheen PJ, Gooiker GA, Eddes EH, Kievit J, Tollenaar RA, Wouters MW, Dutch Surgical Colorectal Audit Group. Variation in case-mix between hospitals treating colorectal cancer patients in the Netherlands. Eur J Surg Oncol. 2011;37(11):956–63.PubMedCrossRefGoogle Scholar
  16. 16.
    Park CC, Mitsumori M, Nixon A, Recht A, Connolly J, Gelman R, Silver B, Hetelekidis S, Abner A, Harris JR, et al. Outcome at 8 years after breast-conserving surgery and radiation therapy for invasive breast cancer: influence of margin status and systemic therapy on local recurrence. J Clin Oncol. 2000;18(8):1668–75.PubMedGoogle Scholar
  17. 17.
    Moran MS, Haffty BG. Local-regional breast cancer recurrence: prognostic groups based on patterns of failure. Breast J. 2002;8(2):81–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Panet-Raymond V, Truong PT, McDonald RE, Alexander C, Ross L, Ryhorchuk A, Watson PH. True recurrence versus new primary: an analysis of ipsilateral breast tumor recurrences after breast-conserving therapy. Int J Radiat Oncol Biol Phys. 2011;81(2):409–17.PubMedCrossRefGoogle Scholar
  19. 19.
    Lilford R, Mohammed MA, Spiegelhalter D, Thomson R. Use and misuse of process and outcome data in managing performance of acute medical care: avoiding institutional stigma. Lancet. 2004;363(9415):1147–54.PubMedCrossRefGoogle Scholar
  20. 20.
    Tjan-Heijnen VC, Van Bommel ACM, van der Heiden-van der Loo M, Westenend PJ, De Vries B, Smorenburg CH, Jager A, Lobbes MB, Pijnappel RM, Maduro JH, et al. Multidisciplinary breast cancer care registry and quality control system in the Netherlands: The NABON breast cancer audit. In 37th Annual San Antonio Breast Cancer Symposium. San Antonio;2014.Google Scholar
  21. 21.
    Van Bommel ACM, Vrancken Peeters MJ, van der Heiden-van der Loo M, Van Dalen T, Rutgers E, Wouters MW, Lobbes MB, Pijnappel RM, Mureau MA, Westenend PJ, et al. The NABON breast cancer audit; quality improvement in three years’ time. In 27th Annual San Antonio Breast Cancer Symposium. San Antonio;2014.Google Scholar

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • M. van der Heiden-van der Loo
    • 1
  • S. Siesling
    • 1
    • 2
  • M. W. J. M. Wouters
    • 3
  • T. van Dalen
    • 4
  • E. J. T. Rutgers
    • 3
  • P. H. M. Peeters
    • 5
  1. 1.Department of ResearchNetherlands Comprehensive Cancer OrganisationUtrechtThe Netherlands
  2. 2.Department of Health Technology and Services Research, MIRA Institute of Biomedical Science and Technical MedicineTwente UniversityEnschedeThe Netherlands
  3. 3.Department of SurgeryNetherlands Cancer Institute-Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  4. 4.Department of SurgeryDiakonessenhuis UtrechtUtrechtThe Netherlands
  5. 5.Julius Center of Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands

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