Where Breast Cancer Patients Get the Best Care
May 06, 2019
Where is a breast cancer patient likely to receive the most evidence-based, guideline-compliant care? At a breast center accredited by the Commission on Cancer (CoC), and by the newer, breast cancer-specific National Accreditation Program for Breast Cancers (NAPBC).
This is the finding from a new study published in the journal Annals of Surgical Oncology. The study is the first to specifically address the question.
UH breast surgeon Megan E. Miller, MD, and colleagues across the country reviewed 2015 data on breast cancer patients, treatments and facilities from the National Cancer Database. They then looked at six quality measures shared by the CoC and NAPBC. Lastly, they compared compliance with these quality measures between CoC centers and those with the extra NAPBC accreditation.
Results show that NAPBC centers achieved significantly higher performance on four of the five quality measures than non-NAPBC centers at the patient level, and on five of the six measures at the facility level.
NAPBC centers were twice as likely as non-NAPBC centers to meet the standard on measures such as performing a needle biopsy before surgical treatment of breast cancer and needle and achieving a target rate of 50 percent for breast conservation surgery among patients with early-stage breast cancer.
Receiving Recommended Treatment
One important finding was that the majority of breast cancer patients at all centers received care that followed established guidelines.
“The good news is that more than 80 percent of patients are receiving guideline-concordant care, no matter where they are going for their care, as long as they are at an accredited center,” Dr. Miller says.
According to the study, 37 percent of CoC-facilities were also NAPBC-accredited in 2015, with 48 percent of breast cancer patients being treated at such a facility.
“This shows that patients are seeking out those specialized breast cancer centers, instead of just generalized cancer care,” Dr. Miller says.
Differences in Accredited Centers
What explains the differences seen in the study between NAPBC and non-NAPBC centers?
“We think at the NAPBC centers, there is more coordinated care because they have the resources to dedicate solely to breast cancer care, as opposed to CoC centers, which are caring for all patients with cancer,” Dr. Miller says. “Some of the quality measures speak to the multidisciplinary nature of care, and that may be provided better at NAPBC centers.”
As different quality measures for breast cancer emerge, Dr. Miller says, the group plans to revisit the project.
Ultimately, the team also would like to link quality measures to improved patient outcomes.
”Our next step would be to look at recurrence data and survival data for patients who received care in compliance with the guidelines and those who didn’t,” Dr. Miller says.
For now, however, the implications of this study are enormous.
“This is the first study that has looked at breast quality measures, even though they’ve been in existence for more than 10 years,” she says. “Our aim was to drill down to find out which centers are performing well. We were pleasantly surprised by our outcomes. Most patients really are receiving good care. It’s just a matter of getting every center up to the same standard or [physicians] appropriately referring to accredited breast centers when needed.
“The patient comes first,” she says. “Guidelines matter. They were not created just so we can check a box, but to truly improve patient care.”
At UH, all breast centers are NAPBC-accredited. This includes facilities at UH Cleveland Medical Center, UH Ahuja Medical Center, UH Elyria Medical Center, UH Geauga Medical Center, UH St. John Medical Center, UH Minoff Health Center at Chagrin Highlands, UH Westlake Health Center and joint-venture Southwest General Health Center.