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

  • Healthcare Policy and Outcomes
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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References

  1. American Cancer Society. http://www.cancer.org/downloads/STT/Global_Facts_and_Figures_2007rev2.pdf. Accessed October 12, 2009.

  2. American Society of Clinical Oncologists. http://www.qualityforum.org/. Accessed October 12, 2009.

  3. American Society of Breast Surgeons. http://breastsurgeons.org/. Accessed October 12, 2009.

  4. National Accreditation Program for Breast Centers. http://accreditedbreastcenters.org/. Accessed October 12, 2009.

  5. Hassett MJ, Hughes ME, Niland JC, et al. Selecting high priority quality measures for breast cancer quality improvement. Med Care. 2008;46:762–70.

    Article  PubMed  Google Scholar 

  6. National Quality Forum. http://www.qualityforum.org/. Accessed October 12, 2009.

  7. Cheng SH, Wang CJ, Lin JL, Horng CF, Lu MC, Asch SM, et al. Adherence to quality indicators and survival in patients with breast cancer. Med Care. 2009;47:217–25.

    Article  PubMed  Google Scholar 

  8. Schacter AM, Mamaladze V, Lewin G, Graham ID, Brouwers M, Sampson M, et al. Many quality measurements, but few quality measures assessing the quality of breast cancer care in women: a systematic review. BMC Cancer. 2006;6:291.

    Google Scholar 

  9. Brucker SY, Schumacher C, Sohn C, Rezai M, Bamberg M, Wallwiener D. (2008) Steering Committee. Benchmarking the quality of breast cancer care in a nationwide voluntary system: the first five-year results (2003–2007) from Germany as a proof of concept. BMC Cancer. 8:358.

    Article  PubMed  Google Scholar 

  10. Mandelblatt JS, Potosky AL. On the road to improving the quality of breast cancer care: a distance still to travel. Med Care. 2008;46:759–61.

    Article  PubMed  Google Scholar 

  11. Malin JL, Schneider EC, Epstein AM, et al. Results of the National Initiative for Cancer Care Quality. How can we improve the quality of cancer care in the United States? J Clin Oncol. 2006;24:626–33.

    Article  PubMed  Google Scholar 

  12. Desch CE, McNiff KK, Schneider EC, et al. American Society of Clinical Oncology/National Comprehensive Cancer Network quality measures. J Clin Oncol. 2008;26:3631–7.

    Article  PubMed  Google Scholar 

  13. National Quality Forum. NQF-endorsed standards. http://www.qualityforum.org/Measures_List.aspx?keyword=breast+cancer. Accessed October 12, 2009.

  14. Wilke LG, McCall LM, Posther KE, et al. Surgical complications associated with sentinel lymph node biopsy: results from a prospective international cooperative group trial. Ann Surg Oncol. 2006;13:491–500.

    Article  PubMed  Google Scholar 

  15. Leitch AM, Beitsch PD, McCall LM, et al. Patterns of participation and successful patient recruitment to American College of Surgeons Oncology Group Z0010, a phase II trial for patients with early-stage breast cancer. Am J Surg. 2005;190:539–42.

    Article  PubMed  Google Scholar 

  16. Posther KE, McCall LM, Blumencranz PW, et al. Sentinel node skills verification and surgeon performance: data from a multicenter clinical trial for early-stage breast cancer. Ann Surg. 2005;242:593–9.

    PubMed  Google Scholar 

  17. American College of Surgeons. http://www.facs.org/cancer/publicncdb.html. Accessed October 12, 2009.

  18. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.

    Article  PubMed  Google Scholar 

  19. Veronesi U, Cascinelli N, Mariani L. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.

    Article  PubMed  Google Scholar 

  20. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomized trials. Lancet. 2005;365:1687–717.

    Article  Google Scholar 

  21. Smith BD, Smith GL, Roberts KB, et al. Baseline utilization of breast radiotherapy before institution of the Medicare practice quality reporting initiative. Int J Radiat Oncol Biol Phys. 2009;74:1506–12.

    PubMed  Google Scholar 

  22. Buchholz TA, Theriault RL, Niland JC, et al. The use of radiation as a component of breast conservation therapy in National Comprehensive Cancer Network centers. J Clin Oncol. 2006;24:361–9.

    Article  PubMed  Google Scholar 

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Acknowledgment

This work was supported by funding from the NCI ACOSOG U10 CA 76001. We thank the all of the investigators and their site research teams, and in particular the patients with breast cancer and their caregivers who participated in the Z0010 study.

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Authors and Affiliations

  1. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Lee G. Wilke MD

  2. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA

    Karla V. Ballman PhD & Linda M. McCall MS

  3. John Wayne Cancer Institute Breast Center, Santa Monica, CA, USA

    Armando E. Giuliano MD

  4. Nashville Breast Center, Vanderbilt University, Nashville, TN, USA

    Pat W. Whitworth MD

  5. Moffitt Morton Plant Cancer Center, Clearwater, FL, USA

    Peter W. Blumencranz MD

  6. Lakeland Regional Cancer Center, Lakeland, FL, USA

    Douglas S. Reintgen MD

  7. Department of Surgery, Ohio State University, Columbus, OH, USA

    William E. Burak MD

  8. Department of Surgery, Southwestern Medical Center, University of Texas, Dallas, TX, USA

    A. Marilyn Leitch MD

  9. Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    Kelly K. Hunt MD

Authors
  1. Lee G. Wilke MD
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  2. Karla V. Ballman PhD
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  3. Linda M. McCall MS
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  4. Armando E. Giuliano MD
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  5. Pat W. Whitworth MD
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  6. Peter W. Blumencranz MD
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  7. Douglas S. Reintgen MD
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  8. William E. Burak MD
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  9. A. Marilyn Leitch MD
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  10. Kelly K. Hunt MD
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Corresponding author

Correspondence to Lee G. Wilke MD.

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Wilke, L.G., Ballman, K.V., McCall, L.M. et al. Adherence to the National Quality Forum (NQF) Breast Cancer Measures Within Cancer Clinical Trials: A Review From ACOSOG Z0010. Ann Surg Oncol 17, 1989–1994 (2010). https://doi.org/10.1245/s10434-010-0980-9

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  • DOI: https://doi.org/10.1245/s10434-010-0980-9

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