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15.11.2018 | Preclinical study

Treatment delays from transfers of care and their impact on breast cancer quality measures

verfasst von: Richard J. Bleicher, Cecilia Chang, Chihsiung E. Wang, Lori J. Goldstein, Cary S. Kaufmann, Meena S. Moran, Karen A. Pollitt, Nicholas R. Suss, David P. Winchester, Lorraine Tafra, Katharine Yao

Erschienen in: Breast Cancer Research and Treatment | Ausgabe 3/2019

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Abstract

Purpose

Despite delays between diagnosis and surgery adversely affecting survival, patients frequently transfer their breast cancer care between institutions. This study was performed to assess the prevalence and effect of such transfers of care (TsOC) on the time to surgery, and its impact on current time-dependent breast cancer quality metrics at Commission on Cancer (CoC) and National Accreditation Program for Breast Centers (NAPBC)-accredited institutions.

Methods

Patients having non-metastatic invasive breast cancer diagnosed between 2006 and 2015 at CoC and NAPBC centers (“reporting facilities”) in the National Cancer Database were reviewed. TsOC refer to transferring into or out of a reporting facility between diagnosis and surgery.

Results

Among 622,793 patients, 36.6% of patients transferred care. TsOC add 7.3, 7.8, 8.7, and 9.8 days in time to surgery, chemotherapy, radiotherapy, and endocrine therapy, respectively (p’s < 0.0001). On multivariable analysis, the odds of surgery occurring > 90 days from diagnosis were greatest for patients undergoing unilateral or bilateral mastectomy, Black or Hispanic patients, and those having TsOC (ORs > 1.73, p’s < 0.0001). TsOC increase the odds of non-compliance, per patient, for chemotherapy, radiotherapy and endocrine therapy time-dependent measures by 65.4%, 25.6%, and 56.5%, respectively (p < 0.0001).

Conclusions

TsOC for newly diagnosed breast cancers to or from an accredited facility result in delays in time to surgery which can affect compliance with time-dependent quality measures. Facilities frequently receiving transferred patients may be most adversely affected. Although non-compliance with these quality measures is low, institutions and accrediting bodies should be aware of these associations in order to comply with time-dependent standards.

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Titel: Treatment delays from transfers of care and their impact on breast cancer quality measures
verfasst von: Richard J. Bleicher
Cecilia Chang
Chihsiung E. Wang
Lori J. Goldstein
Cary S. Kaufmann
Meena S. Moran
Karen A. Pollitt
Nicholas R. Suss
David P. Winchester
Lorraine Tafra
Katharine Yao
Publikationsdatum: 15.11.2018
Verlag: Springer US
Erschienen in: Breast Cancer Research and Treatment / Ausgabe 3/2019
Print ISSN: 0167-6806
Elektronische ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-018-5046-x

Springer Medizin

Treatment delays from transfers of care and their impact on breast cancer quality measures