Quality of Breast Cancer Care: What Do We Know?

Malin, Jennifer L.; Schuster, Mark A.; Kahn, Katherine A.; Brook, Robert H.

doi:10.1200/jco.2002.04.020

Cited by 87 publications

(61 citation statements)

References 74 publications

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“…In only one scenario (DCIS) was the majority of women treated according to either standard. These findings are consistent with a 1998 study of physician adherence with US National Institutes of Health clinical practice guidelines for early stage breast cancer, and with a 2002 study of all beneficial breast cancer diagnostic and therapeutic interventions (Lazovich et al, 1991;Malin et al, 2002). Patient and physician characteristics had inconsistent relation to treatment.…”

Section: Discussionsupporting

confidence: 79%

Breast cancer treatment in clinical practice compared to best evidence and practice guidelines

et al. 2004

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There is sparse evidence on community practice patterns in treating women with breast cancer. This study compared care of women with breast cancer with evidence from meta-analyses and US National Comprehensive Cancer Network (NCCN) clinical guidelines. Records of 4395 women with breast cancer were abstracted from practices of 19 surgeon oncologists in six specialty practices in the Philadelphia region during 1995 -1999. Patients were followed through December 2001. Low-frequency data were obtained on all patients. All other data were from a random sample of 464 women, minimum of 50 patients per practice. Actual care provided was compared to NCCN guidelines and results of meta-analyses. Fewer than half the women received treatments reflecting meta-analysis results or NCCN guidelines, by disease stage/TNM status. Adherence to either standard varied from 0% for LCIS to 87% for stages IIA or IIB node positive. There are multiple interactive reasons for low adherence to guidelines or meta-analyses results, including insufficient health system supports to clinicians, inadequate organisation and delivery systems and ineffective continuing medical education. The paucity of written information from patient records on physician/patient interactions limits the understanding of treatment decisions. (Farrow et al, 1996;Coleman et al, 1999;Polednak, 2000;Morrow et al, 2001). The objective of this study was to compare actual care with published guidelines and best evidence from meta-analyses. METHODS AND MATERIALS Study site and patient accrualSix single-specialty surgical oncology practices in northeastern US with 19 oncology surgeons participated. Patients entered the study after diagnosis of breast cancer and operation between 1 January 1995 and 31 December 1999, and were followed through 31 December 2001. None were in clinical trials.We used two sampling methods to collect data. From the total patient population (n ¼ 4395) we collected specific low-frequency data determined by study pretest. Next, we selected a random sample (n ¼ 464) from each practice based on volume of breast cancer patients, with a minimum of 50 patients from each practice.Utilisation of five treatments were selected because each were included in clinical practice guidelines and confirmed by metaanalyses:1. breast-conserving surgery (BCS) and mastectomy; 2. breast reconstruction following operation; 3. adjuvant cytotoxic chemotherapy; 4. radiation; 5. nonsteroidal antioestrogens. Treatment algorithmsWe chose four treatment algorithms from two sources. Treatment recommendations by both were the same or similar by diagnosis and stage. The first comparator was the US National Comprehensive Cancer Network (NCCN) clinical practice guidelines (NCNN, 1996). The second was derived from treatment-specific metaanalyses of optimal care for each clinical scenario by diagnosis/ TNM/stage. We used only meta-analyses published before 1996 as 1995 was the beginning of patient enrollment.Breast-conserving surgery or mastectomy NCCN guideline: For DCIS, LCIS and stage...

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Section: Discussionsupporting

confidence: 79%

Breast cancer treatment in clinical practice compared to best evidence and practice guidelines

et al. 2004

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“…Breast cancer has one of the most extensive scientific literatures on quality of care [4] and has demonstrated an association between pattern of care and outcome [5]. In the case of early breast cancer, it is well known that, though conservative surgery followed by radiation therapy leads to survival rates similar to those provided by total mastectomy, quality of life outcomes are much better [6,7].…”

Section: Introductionmentioning

confidence: 99%

Appropriateness of early breast cancer management in relation to patient and hospital characteristics: a population based study in Northern Italy

Rosato

Sacerdote

Pagano

et al. 2008

Breast Cancer Res Treat

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Administrative data may provide valuable information for monitoring the quality of care at population level and offer an efficient way of gathering data on individual patterns of care, and also to shed light on inequalities in access to appropriate medical care. The aim of the study was to investigate the role of patient and hospital characteristics in the initial treatment of early breast cancer using administrative data. Incident breast cancer patients were identified from hospital discharge records and linked to the radiotherapy outpatient database during 2000-2004 in the Piedmont region of Northwestern Italy. Women treated with breast-conserving surgery followed by radiotherapy (BCS ? RT) were compared to those treated with BCS without radiotherapy (BCS w/o RT) or mastectomy using multinomial logistic regression models. Out of 16,022 incident cases, 46.2% received BCS ? RT, 20.3% received BCS w/o RT, and 33.5% received a mastectomy. Compared to BCS ? RT, the factors associated with BCS w/o RT were: increased age (OR = 1.54; 95% CI = 1.29-1.85, for ages 70-79 vs. \50), being unmarried (1.24; 1.13-1.36), presence of co-morbidities (1.32; 1.10-1.58), being treated at hospitals with low surgical volume (1.31; 1.07-1.60 for hospitals with less than 50 vs. C150 interventions/year), and living far from radiotherapy facilities (1.75; 1.39-2.20 for those at a distance of [45 min). These same factors were also associated with mastectomy. During the 5-year period observed, there was a trend of reduced probability of receiving a mastectomy (0.70; 0.56-0.88 for 2004 vs. 2000). The presence or absence of nodal involvement was positively associated with mastectomy (2.28; 1.83-2.85) and negatively associated with BCS w/o RT (0.65; 0.56-0.76). After adjustment for potential confounders, education level did not show any association with the type of treatment. Social and geographical factors, in addition to hospital specialization, should be considered to reduce inappropriateness of care for breast cancer.

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“…1,2 Much has been done towards developing a methodology to measure quality of care, 2,3 quality of care for cancer patients, 4,5 and, in particular, quality of care for breast cancer patients. [6][7][8] However, developments in measuring quality end-of-life care have been slower than other phases of the cancer care continuum. 9,10 Quality of care has been defined as the 'degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge'.…”

Section: Introductionmentioning

confidence: 99%

Towards using administrative databases to measure population-based indicators of quality of end-of-life care: testing the methodology

et al. 2006

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This study is concerned with methods to measure population-based indicators of quality end-oflife care. Using a retrospective cohort approach, we assessed the feasibility, validity and reliability of using administrative databases to measure quality indicators of end-of-life care in two Canadian provinces. The study sample consisted of all females who died of breast cancer between 1 January 1998 and 31 December 2002, in Nova Scotia or Ontario, Canada. From an initial list of 19 quality indicators selected from the literature, seven were determined to be fully measurable in both provinces. An additional seven indicators in one province and three in the other province were partially measurable. Tests comparing administrative and chart data show a high level of

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Quality of Breast Cancer Care: What Do We Know?

Cited by 87 publications

References 74 publications

Breast cancer treatment in clinical practice compared to best evidence and practice guidelines

Breast cancer treatment in clinical practice compared to best evidence and practice guidelines

Appropriateness of early breast cancer management in relation to patient and hospital characteristics: a population based study in Northern Italy

Towards using administrative databases to measure population-based indicators of quality of end-of-life care: testing the methodology

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