Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2015

01-12-2015 | Breast Oncology

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

Authors: M. van der Heiden-van der Loo, PhD, S. Siesling, PhD, M. W. J. M. Wouters, MD, PhD, T. van Dalen, MD, PhD, E. J. T. Rutgers, MD, PhD, P. H. M. Peeters, MD, PhD

Published in: Annals of Surgical Oncology | Special Issue 3/2015

Login to get access

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.
Literature
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.PubMedCrossRef
2.
Donabedian A: Evaluating the quality of medical care. Milbank Q. 1966;83(4):691–729.CrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
6.
Rutgers EJ, Wittenberg J, Kuijpers AC. Kwaliteit van zorg rond mammacarcinoom in de etalage. In: Utrecht: CBO, Orde van Medisch Specialisten; 2006.
7.
Rutgers EJ, Group EC. Quality control in the locoregional treatment of breast cancer. Eur J Cancer. 2001;37(4):447–53.PubMedCrossRef
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.
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.PubMedCrossRef
10.
Sobin LH, Wittekind C. TNM Classification of malignant tumours. International Union against cancer (UICC), vol. 6. New York: Wiley-Liss; 2002.
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.PubMedPubMedCentralCrossRef
12.
Spiegelhalter DJ. Funnel plots for comparing institutional performance. Stat Med. 2005;24(8):1185–202.PubMedCrossRef
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.PubMedCrossRef
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.CrossRef
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.PubMedCrossRef
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.PubMed
17.
Moran MS, Haffty BG. Local-regional breast cancer recurrence: prognostic groups based on patterns of failure. Breast J. 2002;8(2):81–7.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
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.
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.
Metadata
Title
The Value of Ipsilateral Breast Tumor Recurrence as a Quality Indicator: Hospital Variation in the Netherlands
Authors
M. van der Heiden-van der Loo, PhD
S. Siesling, PhD
M. W. J. M. Wouters, MD, PhD
T. van Dalen, MD, PhD
E. J. T. Rutgers, MD, PhD
P. H. M. Peeters, MD, PhD
Publication date
01-12-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue Special Issue 3/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4626-9

Other articles of this Special Issue 3/2015

Annals of Surgical Oncology 3/2015 Go to the issue

Endocrine Tumors

Intraoperative Parathormone Monitoring Mitigates Age-Related Variability in Targeted Parathyroidectomy for Patients with Primary Hyperparathyroidism

Radiation Oncology

Single-Institution Multidisciplinary Management of Locoregional Oligo-Recurrent Pelvic Malignancies: Long-Term Outcome Analysis

Head and Neck Oncology

Two-Year Survival Analysis of 50 Consecutive Head and Neck Cancer Patients Treated with Transoral Robotic Surgery in a Single European Centre

Reconstructive Oncology

Current Trends and Emerging Future of Indocyanine Green Usage in Surgery and Oncology: An Update

Erratum

Erratum to: Anesthetic Selection and Disease-Free Survival Following Optimal Primary Cytoreductive Surgery for Stage III Epithelial Ovarian Cancer

Erratum

Erratum to: Skeletal Muscle Depletion is Associated with Severe Postoperative Complications in Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis of Colorectal Cancer