Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Ann Surg Oncol. 2021 Dec;28(13):8589-8599. doi: 10.1245/s10434-021-10028-8. Epub 2021 Jun 16.
The Commission on Cancer (CoC) issues Cancer Program Practice Profile Reports (CP3R) that set standards for high-quality care. Three metrics for breast cancer include radiation within 1 year for women < 70 years of age receiving breast-conserving surgery, radiation within 1 year after mastectomy for women with four or more positive lymph nodes (MASTRT), and hormonal therapy within 1 year of a stage IB-III hormone receptor-positive breast cancer (HT). Our study evaluates national trends in quality metric compliance.
The National Cancer Database was queried from 2004 to 2014 to identify patients who met the criteria for the three quality metrics. National trends in compliance were compared.
Overall, 1,094,264 patients qualified for BCSRT (n = 534,147), MASTRT (n = 66,291), or HT (n = 493,826). In 2014, 91.1% of patients met BCSRT, 88.4% met MASTRT, and 90.7% met HT. BCSRT, MASTRT, and HT compliance rates were lower in community hospitals compared with Integrated Network Cancer Programs (INCP) (BCSRT: 89.0% vs. 92.8%, p < 0.01; MASTRT: 85.5% vs. 90.6%, p < 0.01; HT: 87.3% vs. 93.7%, p < 0.01). On multivariate analysis, patients receiving care at an INCP facility [odds ratio (OR) 1.47, 95% confidence interval (CI) 1.37-1.58] and insured patients (OR 1.70, 95% CI 1.54-1.87) had higher odds of BCSRT compliance, and minorities (OR 0.76, 95% CI 0.73-0.80) had lower odds. Similar results were seen for MASTRT and HT.
In more recent years, overall compliance rates for breast cancer quality metrics of BCSRT and HT by Comprehensive Community Cancer Programs, Academic/Research Programs, and INCPs have increased to meet the 90% CoC standards, while MASTRT has regressed. Community programs were least compliant with meeting the CoC standards.
癌症委员会（CoC）发布癌症计划实践概况报告（CP3R），为高质量护理设定标准。乳腺癌的三个指标包括<70 岁接受保乳手术的女性在 1 年内接受放疗、有 4 个以上阳性淋巴结的女性在 1 年内接受乳房切除术放疗（MASTRT）以及激素受体阳性 I 期至 III 期乳腺癌（HT）患者在 1 年内接受激素治疗。我们的研究评估了全国范围内质量指标达标情况的趋势。
从 2004 年到 2014 年，国家癌症数据库被查询，以确定符合三项质量指标的患者。比较了全国范围内达标情况的趋势。
总体而言，1094264 名患者符合 BCSRT（n=534147）、MASTRT（n=66291）或 HT（n=493826）标准。2014 年，91.1%的患者符合 BCSRT 标准，88.4%符合 MASTRT 标准，90.7%符合 HT 标准。社区医院的 BCSRT、MASTRT 和 HT 达标率低于综合网络癌症项目（INCP）（BCSRT：89.0%比 92.8%，p<0.01；MASTRT：85.5%比 90.6%，p<0.01；HT：87.3%比 93.7%，p<0.01）。多变量分析显示，在 INCP 机构接受治疗的患者[比值比（OR）1.47，95%置信区间（CI）1.37-1.58]和保险患者（OR 1.70，95%CI 1.54-1.87）BCSRT 达标率更高，少数民族（OR 0.76，95%CI 0.73-0.80）的达标率较低。MASTRT 和 HT 也有类似的结果。
近年来，综合社区癌症项目、学术/研究项目和 INCP 乳腺癌 BCSRT 和 HT 的整体达标率已提高到符合癌症委员会 90%的标准，而 MASTRT 的达标率则有所下降。社区项目最不符合癌症委员会的标准。
