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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2016

01-10-2016 | Breast Oncology

Time to Treatment: Measuring Quality Breast Cancer Care

Authors: Amy C. Polverini, MD, Rebecca A. Nelson, PhD, Emily Marcinkowski, MD, Veronica C. Jones, MD, Lily Lai, MD, Joanne E. Mortimer, MD, Lesley Taylor, MD, Courtney Vito, MD, John Yim, MD, Laura Kruper, MD

Published in: Annals of Surgical Oncology | Issue 10/2016

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Abstract

Background

To optimize breast cancer care, several organizations have crafted guidelines to define best practices for treating breast cancer. In addition to recommended therapies, ‘timeliness of treatment’ has been proposed as a quality metric. Our study evaluates time to surgical treatment and its effect on overall survival (OS).

Methods

The National Cancer Data Base (NCDB) was used to identify women diagnosed with invasive breast cancer between 2004 and 2012. Time from diagnosis to surgical treatment was calculated and grouped according to predetermined time intervals. Univariate and multivariate Cox proportional hazard models were used to assess patient and treatment factors related to OS.

Results

Overall, 420,792 patients initially treated with surgery were identified. Increased time to surgical treatment >12 weeks was associated with decreased OS [hazard ratio (HR) 1.14, 95 % confidence interval (CI) 1.09–1.20]. When stratified by pathologic stage, stage I patients treated at 8 to <12 weeks (HR 1.07, 95 % CI 1.02–1.13) and >12 weeks (HR 1.19, 95 % CI 1.11–1.28), as well as stage II patients treated at >12 weeks (HR 1.16, 95 % CI 1.08–1.25), had decreased OS compared with patients treated at <4 weeks. Other variables associated with decreased survival were treatment at a community cancer program, Medicaid or Medicare insurance, Black race, increasing age, mastectomy, moderately and poorly differentiated tumor grade, increasing T and N stage, and higher Charlson Index Group.

Conclusion

The survival benefit of expedited time to initial surgical treatment varies by stage and appears to have the greatest impact in early-stage disease. Prior to establishing standard metrics, further quantification of the impact on patient outcomes is needed.
Literature
1.
Hewitt M, Simone JV. Ensuring quality cancer care. Washington DC: National Academies Press; 1999.
2.
3.
Del Turco MR, Ponti A, Bick U, et al. Quality indicators in breast cancer care. Eur J Cancer. 2010;46(13):2344–56.CrossRefPubMed
4.
Kaufman CS, Shockney L, Rabinowitz B, et al. National Quality Measures for Breast Centers (NQMBC): a robust quality tool: breast center quality measures. Ann Surg Oncol. 2010;17(2):377–85.CrossRefPubMed
5.
McCahill LE, Privette A, James T, et al. Quality measures for breast cancer surgery: initial validation of feasibility and assessment of variation among surgeons. Arch Surg. 2009;144(5):455–62 (discussion 462–53).
6.
Rose C, Stovall E, Ganz PA, Desch C, Hewitt M. Cancer quality alliance: blueprint for a better cancer care system. CA Cancer J Clin. 2008;58(5):266–92.CrossRefPubMed
7.
Malin JL, Schneider EC, Epstein AM, Adams J, Emanuel EJ, Kahn KL. 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(4):626–34.CrossRefPubMed
8.
Wilson AR, Marotti L, Bianchi S, et al. The requirements of a specialist breast centre. Eur J Cancer. 2013;49(17):3579–87.CrossRefPubMed
9.
Bleicher RJ, Ciocca RM, Egleston BL, et al. Association of routine pretreatment magnetic resonance imaging with time to surgery, mastectomy rate, and margin status. J Am Coll Surg. 2009;209(2):180–7 (quiz 294–185).
10.
Pesce CE, Liederbach E, Czechura T, Winchester DJ, Yao K. Changing surgical trends in young patients with early stage breast cancer, 2003 to 2010: a report from the National Cancer Data Base. J Am Coll Surg. 2014;219(1):19–28.CrossRefPubMed
11.
Boudreau RM, McNally C, Rensing EM, Campbell MK. Improving the timeliness of written patient notification of mammography results by mammography centers. Breast J. 2004;10(1):10–19.CrossRefPubMed
12.
Brewer NT, Salz T, Lillie SE. Systematic review: the long-term effects of false-positive mammograms. Ann Intern Med. 2007;146(7):502–10.CrossRefPubMed
13.
Ferrante JM, Chen PH, Kim S. The effect of patient navigation on time to diagnosis, anxiety, and satisfaction in urban minority women with abnormal mammograms: a randomized controlled trial. J Urban Health. 2008;85(1):114–24.CrossRefPubMed
14.
Landercasper J, Linebarger JH, Ellis RL, et al. A quality review of the timeliness of breast cancer diagnosis and treatment in an integrated breast center. J Am Coll Surg. 2010;210(4):449–55.CrossRefPubMed
15.
Loftus L, Laronga C, Coyne K, Hildreth L. Race of the clock: reducing delay to curative breast cancer surgery. J Natl Compr Canc Netw. 2014;12 Suppl 1:S13–15.PubMed
16.
Bleicher RJ, Ruth K, Sigurdson ER, et al. Time to surgery and breast cancer survival in the United States. JAMA Oncol. 2016;2(3):330–9.CrossRefPubMed
17.
Richards MA, Westcombe AM, Love SB, Littlejohns P, Ramirez AJ. Influence of delay on survival in patients with breast cancer: a systematic review. Lancet. 1999;353(9159):1119–26.CrossRefPubMed
18.
Killelea BK, Yang VQ, Wang SY, et al. Racial differences in the use and outcome of neoadjuvant chemotherapy for breast cancer: results from the National Cancer Data Base. J Clin Oncol. 2015;33(36):4267–76.CrossRefPubMed
19.
Tichy JR, Deal AM, Anders CK, Reeder-Hayes K, Carey LA. Race, response to chemotherapy, and outcome within clinical breast cancer subtypes. Breast Cancer Res Treat. 2015;150(3):667–74.CrossRefPubMedPubMedCentral
20.
DeSantis CE, Siegel RL, Sauer AG, et al. Cancer statistics for African Americans, 2016: progress and opportunities in reducing racial disparities. CA Cancer J Clin. 2016;66(4):290–308.CrossRefPubMed
21.
Warner ET, Tamimi RM, Hughes ME, et al. Racial and ethnic differences in breast cancer survival: mediating effect of tumor characteristics and sociodemographic and treatment factors. J Clin Oncol. 2015;33(20):2254–61.CrossRefPubMedPubMedCentral
22.
Shi R, Taylor H, McLarty J, Liu L, Mills G, Burton G. Effects of payer status on breast cancer survival: a retrospective study. BMC Cancer. 2015;15:211.CrossRefPubMedPubMedCentral
23.
24.
Kurian AW, Lichtensztajn DY, Keegan TH, Nelson DO, Clarke CA, Gomez SL. Use of and mortality after bilateral mastectomy compared with other surgical treatments for breast cancer in California, 1998–2011. JAMA. 2014;312(9):902–14.CrossRefPubMed
25.
van Maaren MC, de Munck L, de Bock GH, et al. Higher 10-year overall survival after breast conserving therapy compared to mastectomy in early stage breast cancer: a population-based study with 37,207 patients [Abstract No. S3-05]. Presented at the 38th Annual San Antonio Breast Cancer Symposium: 8–12 Dec 2015; San Antonio.
26.
Dillman RO, Chico SD. Cancer patient survival improvement is correlated with the opening of a community cancer center: comparisons with intramural and extramural benchmarks. J Oncol Pract. 2005;1(3):84–92.CrossRefPubMedPubMedCentral
27.
Hulvat M, Sandalow N, Rademaker A, Helenowski I, Hansen NM. Time from diagnosis to definitive operative treatment of operable breast cancer in the era of multimodal imaging. Surgery. 2010;148(4):746–50 (discussion 750–41).
Metadata
Title
Time to Treatment: Measuring Quality Breast Cancer Care
Authors
Amy C. Polverini, MD
Rebecca A. Nelson, PhD
Emily Marcinkowski, MD
Veronica C. Jones, MD
Lily Lai, MD
Joanne E. Mortimer, MD
Lesley Taylor, MD
Courtney Vito, MD
John Yim, MD
Laura Kruper, MD
Publication date
01-10-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 10/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5486-7

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