Surgical/Pathologic Breast Cancer Indicators: Adherence by the Florida Initiative for Quality Cancer Care (FIQCC) Consortium.

Abstract

Abstract Background: The FIQCC is comprised of 11 practice sites across the state that participate in a comprehensive review of quality of care specific to cancer patients across many disease sites. Quality indicators were scripted based on the accepted QOPI, NCCN, ACOS, and site-specific PI panel consensus indicators for breast cancer patients. An evaluation was done to assess adherence to performance indicators among the sites.Methods: Comprehensive chart reviews were conducted for all patients with breast cancer first seen in 2006 by a medical oncologist at one of the 11 FIQCC sites (3 academic/8 community). Quality measures included: 1) presence and completeness of the pathology report (tumor size, grade, specimen orientation, margins inked, margin status, receptor status); 2) documentation of surgery type (breast conserving vs. mastectomy); 3) documentation of sentinel lymph node biopsy (SLNB) and if SLNB positive for metastatic disease documentation of a complete axillary node dissection; 4) mammogram usage post surgery; and 5) referral to radiation. Statistical comparisons were performed using chi-square test.Results: Charts of 622 patients (99% female) with a median age of 60 years (range 22-95) were reviewed. With respect to pathologic reporting, there was strong compliance (>90%) for documentation of a pathology report, AJCC or TMN staging, tumor size and grade, status of margins, and receptor status. However, only 370 of 537 (69%) reports documented that the specimen was oriented and 474 of 537 (88%) stated the margins were inked. Breast conserving surgery was performed in 294 of 539 patients (55%). In clinical N0 patients, SLNB was performed in 447 of 543 (82%). Of the patients with a metastatic SLNB, 123 of 156 (79%) went on to have a complete axillary node dissection. Compliance was highly variable with obtaining a mammogram within 14 months of surgery (77%; range 26-98%). However, referral to radiation within 1 year was highly consistent (97%; range 80-100%). Significant variances across practice sites were noted for the reporting of margin orientation (p<0.001), inking of the margins (p<0.001), performance of SLNB (p<0.001), and obtaining a mammogram within 14 months of surgery (p<0.001).Discussion: The FIQCC allows for identification of the need for quality improvement in multiple aspects of breast cancer care. Findings based on 2006 cases identified a need for improvements in margin orientation and inking, use of SLNB and obtaining mammograms in follow-up after breast conserving surgery. These findings are now being used at the participating sites to guide quality improvement efforts. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1079.