Department of Surgery, University of Chicago, Chicago, IL, USA.
Division of Surgical Oncology, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
Ann Surg Oncol. 2018 Oct;25(10):3069-3075. doi: 10.1245/s10434-018-6592-5. Epub 2018 Jun 28.
Adherence to quality measures has become an important indicator of cancer center performance for high-quality cancer care. We examined regional variation in performance for Commission on Cancer breast quality measures and its impact on overall survival (OS) for those measures that have been shown to impact OS.
Six breast quality measures were analyzed using the National Cancer Data Base from 2014 to 2015, and a multivariable model was used to assess performance for each measure by region. Kaplan-Meier and Cox proportional hazard models were used to examine OS between high- and low-performing centers from 2007 to 2012.
Overall, 305,391 women had surgery at 1322 institutions in nine US regions; 90.8% underwent needle biopsy (range 86.0-92.6% between regions, p < 0.01), 69.8% had breast-conserving surgery (BCS) for stage 0-II cancer (60.9-79.3%, p < 0.01), 85.2% aged < 70 years had radiation therapy (RT) after BCS (79.6-90.8%, p < 0.01), 78.3% of women with four or more positive nodes had post-mastectomy RT (70.9-84.5%, p < 0.01), 90.9% with hormone receptor (HR)-positive stage IB-III cancer had hormone therapy (83.7-95.1%, p < 0.01), and 89.4% aged < 70 years with HR-negative stage IB-III cancer had chemotherapy (87.6-91.4%, p < 0.01). Multivariate analyses adjusted for patient and facility factors found that region was the only consistent predictor of non-compliance across measures. With median 65-month follow-up, there was no difference in OS between high- and low-performing centers for the three measures that have been shown to impact OS.
There is significant regional variation in performance on the breast quality measures but this variation did not impact OS. Targeted efforts in certain areas of the country may help improve performance on these measures.
癌症中心的高质量癌症护理的一个重要指标是对质量措施的坚持。我们研究了癌症委员会乳房质量措施的表现的地区差异，以及对那些已经证明影响生存的措施的整体生存的影响。
使用国家癌症数据库从 2014 年至 2015 年分析了六个乳房质量措施，并使用多变量模型评估了每个地区的每个措施的表现。Kaplan-Meier 和 Cox 比例风险模型用于检查 2007 年至 2012 年高绩效和低绩效中心之间的总生存。
总体而言，305391 名妇女在九个美国地区的 1322 个机构进行了手术；90.8%（86.0-92.6%，p <0.01）接受了针活检，69.8%（60.9-79.3%，p <0.01）接受了保乳手术（BCS）用于 0-II 期癌症，85.2%（79.6-90.8%，p <0.01）的<70 岁的女性在 BCS 后接受放射治疗（RT），78.3%（70.9-84.5%，p <0.01）有四个或更多阳性淋巴结的妇女在乳房切除术（PM）后接受 RT，90.9%（83.7-95.1%，p <0.01）的激素受体（HR）阳性 1B-3 期癌症的妇女接受激素治疗，89.4%（87.6-91.4%，p <0.01）的<70 岁的 HR 阴性 1B-3 期癌症的妇女接受化疗。调整患者和设施因素的多变量分析发现，区域是跨措施不合规的唯一一致预测因素。中位随访 65 个月后，在已经证明影响生存的三个措施中，高绩效和低绩效中心之间的 OS 没有差异。
乳房质量措施的表现存在显著的地区差异，但这种差异并没有影响 OS。在该国某些领域的有针对性的努力可能有助于提高这些措施的绩效。
