Time to Treatment: Measuring Quality Breast Cancer Care
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).
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.
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.
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.
KeywordsOverall Survival National Cancer Data Base Breast Cancer Care Medicare Insurance Preoperative Breast Magnetic Resonance Image
- 1.Hewitt M, Simone JV. Ensuring quality cancer care. Washington DC: National Academies Press; 1999.Google Scholar
- 2.NCCN quality measures in breast cancer. Available at: http://www.instituteforquality.org/asco-nccn-quality-measures. Accessed 10 Feb 2016.
- 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).Google Scholar
- 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).Google Scholar
- 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.Google Scholar
- 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).Google Scholar