A Quality Review of the Timeliness of Breast Cancer Diagnosis and Treatment in an Integrated Breast Center

Abstract

The National Consortium of Breast Centers defines "quality" of breast cancer care as "accurate evaluation and appropriate services ... in a timely manner." We sought to determine timeliness of care and relationship to patient satisfaction. The electronic medical records of breast cancer patients seen at a breast center from 2004 through 2007 were retrospectively reviewed. Dates of patient service were audited. A postal survey was then conducted to determine patient satisfaction with timeliness. Median time interval in business days from abnormal screening mammogram to diagnostic evaluation and core needle biopsy was 6 days. Median time intervals from core needle biopsy to core needle biopsy pathology report and then subsequent surgical consultation and breast cancer operation were 1, 3, and 7 days, respectively. Breast MRI, systemic imaging, plastic surgery consultation, type of surgery, and patient choice prolonged time to treatment. More than 90% of breast cancer patients who responded to our postal survey had their expectations met or exceeded for the dates of service provided for diagnostic evaluation and treatment. Evaluation of timeliness as a quality indicator for breast cancer care is complex and requires an assessment of whether patient expectations were met for dates of service. Factors that prolong time to treatment, such as additional imaging, should be considered for risk adjustment for peer performance comparison and compliance with published timeliness target goals.