Adherence to surgical and oncologic standards improves survival in breast cancer patients

Abstract

Background Adherence to evidence‐based standards can lead to improved outcomes for patients with breast cancer. However, adherence rates to standards and their effects on patient outcomes are unknown. Objectives To examine adherence rates to standards compiled by the American College of Surgeons Clinical Research Program and its effects on patient outcomes. Methods Using the National Cancer Database (2004‐2015), we identified cohorts of breast cancer patients: clinical T1N0M0 under age of 70 (cT1), clinical T2N0M0 or T3N0M0 (cT2/3), and clinical M0 and pathologic N2 or N3 (pN2/3). Standards included negative margins, any adjuvant therapy, and two or more lymph nodes (LNs) examined (for cT1 or cT2/3 patients) or more than 10 LNs examined (for pN2/3 patients). We performed Kaplan‐Meier and Cox proportional hazards analysis. Results We identified 318 853 (65.0%) cT1, 164 593 (67.3%) cT2/3, and 77 626 (67.7%) pN2/3 patients who met the standards. More than 90% of patients had negative margins and adjuvant therapy, but less than 80% met LN standards. The median overall survival (OS) was significantly longer for patients who met the standards. Individual components of the standards were predictors of improved OS. Conclusions One‐third of patients did not meet the evidence‐based standards in their treatment for breast cancer. Efforts to improve the knowledge of and adherence to these standards should be emphasized.

Leveraging the Multidisciplinary Tumor Board for Dissemination of Evidence-Based Recommendations on the Staging and Treatment of Gastric Cancer: A Pilot Study

“…Studies have shown that compliance with cancer surgery standards is associated with improved oncologic outcomes for many cancer types, including colon, breast, and stomach cancers. 4 , 31 , 32 As more surgical standards are developed and converted into CoC metrics, it is increasingly important to understand how to improve compliance so that cancer patients can benefit from these efforts and receive high-quality care. 16 …”

The association between guideline adherence, age and overall survival among women with non-metastatic breast cancer: A systematic review

“…Sixty-seven papers were selected for full-text review; 64 from the electronic databases and three were selected from the reference list of an earlier systematic review [24]. Of these, 16 papers met the study eligibility criteria [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. The stages of the study selection are presented in Figure 1.…”

“…The papers had adopted three main study designs: population-based cohort studies which used cancer registry databases (N = 8) [31-35, 37, 38, 42], multi-centre cohort studies (N = 5) [27,36,[39][40][41], or case series which used data from single institution databases (N = 3) [28][29][30]. Ten studies [27,29,31,32,35,[37][38][39][40][41] reviewed adherence to clinical guidelines, whilst six [28,30,33,34,36,42] used quality indicators or standards. The range of different guidelines, clinical indicators or standards reflected the diverse range of healthcare systems covered (eight studies were conducted in Europe, five in the United States and three in East Asia).…”

Leveraging the 21st Century Cures Act to Improve Cancer Care, Patient Engagement, and Data Collection

“…Studies have shown that patients undergoing surgery for breast cancer whose records included surgical notes indicating adherence to technical standards had significantly longer 5- and 10-year overall survival rates than those whose records did not include proper documentation. 12…”

“…Studies have shown that patients undergoing surgery for breast cancer whose records included surgical notes indicating adherence to technical standards had significantly longer 5-and 10-year overall survival rates than those whose records did not include proper documentation. 12 Structured data entry of important oncologic end points at the point of care will also activate the ability to automatically extract granular and clinically relevant data from the EHR for the purposes of clinical research. Examples of these end points include clinical and pathologic staging data and disease status.…”