Advertisement

Annals of Surgical Oncology

, Volume 23, Issue 10, pp 3392–3402 | Cite as

Time to Treatment: Measuring Quality Breast Cancer Care

  • Amy C. Polverini
  • Rebecca A. Nelson
  • Emily Marcinkowski
  • Veronica C. Jones
  • Lily Lai
  • Joanne E. Mortimer
  • Lesley Taylor
  • Courtney Vito
  • John Yim
  • Laura Kruper
Breast Oncology

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.

Keywords

Overall Survival National Cancer Data Base Breast Cancer Care Medicare Insurance Preoperative Breast Magnetic Resonance Image 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

None.

References

  1. 1.
    Hewitt M, Simone JV. Ensuring quality cancer care. Washington DC: National Academies Press; 1999.Google Scholar
  2. 2.
    NCCN quality measures in breast cancer. Available at: http://www.instituteforquality.org/asco-nccn-quality-measures. Accessed 10 Feb 2016.
  3. 3.
    Del Turco MR, Ponti A, Bick U, et al. Quality indicators in breast cancer care. Eur J Cancer. 2010;46(13):2344–56.CrossRefPubMedGoogle Scholar
  4. 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.CrossRefPubMedGoogle Scholar
  5. 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 46253).Google Scholar
  6. 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.CrossRefPubMedGoogle Scholar
  7. 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.CrossRefPubMedGoogle Scholar
  8. 8.
    Wilson AR, Marotti L, Bianchi S, et al. The requirements of a specialist breast centre. Eur J Cancer. 2013;49(17):3579–87.CrossRefPubMedGoogle Scholar
  9. 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 294185).Google Scholar
  10. 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.CrossRefPubMedGoogle Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. 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.CrossRefPubMedGoogle Scholar
  13. 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.CrossRefPubMedGoogle Scholar
  14. 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.CrossRefPubMedGoogle Scholar
  15. 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.PubMedGoogle Scholar
  16. 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.CrossRefPubMedGoogle Scholar
  17. 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.CrossRefPubMedGoogle Scholar
  18. 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.CrossRefPubMedGoogle Scholar
  19. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 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.CrossRefPubMedGoogle Scholar
  21. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Bleicher RJ, Ruth K, Sigurdson ER, et al. Preoperative delays in the US Medicare population with breast cancer. J Clin Oncol. 2012;30(36):4485–92.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 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.CrossRefPubMedGoogle Scholar
  25. 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
  26. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 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

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Amy C. Polverini
    • 1
  • Rebecca A. Nelson
    • 1
  • Emily Marcinkowski
    • 1
  • Veronica C. Jones
    • 1
  • Lily Lai
    • 1
  • Joanne E. Mortimer
    • 1
  • Lesley Taylor
    • 1
  • Courtney Vito
    • 1
  • John Yim
    • 1
  • Laura Kruper
    • 1
  1. 1.City of Hope National Medical CenterDuarteUSA

Personalised recommendations