Skip to main content

Advertisement

SpringerLink
Log in

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

  • Preclinical study
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bleicher RJ, Ruth K, Sigurdson ER et al (2012) Preoperative delays in the US medicare population with breast cancer. J Clin Oncol 30(36):4485–4492

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bleicher RJ, Ruth K, Sigurdson ER et al (2016) Time to surgery and breast cancer survival in the United States. JAMA Oncol 2(3):330–339

    Article  PubMed  PubMed Central  Google Scholar 

  3. American College of Surgeons (2014) National Accreditation Program for Breast Centers. NAPBC Standards Manual 2014 Edition., 2014:77

  4. National Quality Forum. Measures, reports and tools. http://www.qualityforum.org/Measures_Reports_Tools.aspx

  5. Centers for Medicare and Medicaid Services (CMS). Consensus core set: medical oncology measures version 1.0. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Downloads/Medical-Oncology-Measures.pdf

  6. Churilla TM, Egleston BL, Murphy CT et al (2016) Patterns of multidisciplinary care in the management of non-metastatic invasive breast cancer in the United States Medicare patient. Breast Cancer Res Treat 160(1):153–162

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hillen MA, Medendorp NM, Daams JG et al (2017) Patient-driven second opinions in oncology: a systematic review. Oncologist 22(10):1197–1211

    Article  PubMed  PubMed Central  Google Scholar 

  8. American College of Surgeons. About the National Cancer Database. https://www.facs.org/quality-programs/cancer/ncdb/about

  9. Polverini AC, Nelson RA, Marcinkowski E et al (2016) Time to treatment: measuring quality breast cancer care. Ann Surg Oncol 23(10):3392–3402

    Article  PubMed  Google Scholar 

  10. Ruetters D, Keinki C, Schroth S et al (2016) Is there evidence for a better health care for cancer patients after a second opinion? A systematic review. J Cancer Res Clin Oncol 142(7):1521–1528

    Article  PubMed  Google Scholar 

  11. American College of Surgeons. National Accreditation Program for Breast Centers. NAPBC Standards Manual 2018 Edition. (2018). https://accreditation.facs.org/accreditationdocuments/NAPBC/Portal%20Resources/2018NAPBCStandardsManual.pdf:77. https://accreditation.facs.org/accreditationdocuments/NAPBC/Portal%20Resources/2018NAPBCStandardsManual.pdf

  12. Desch CE, McNiff KK, Schneider EC et al (2008) American Society of Clinical Oncology/national comprehensive cancer network quality measures. J Clin Oncol 26(21):3631–3637

    Article  PubMed  Google Scholar 

  13. Crannell WC, Clark E, Jones C et al (2016) A pattern-matched Twitter analysis of US cancer-patient sentiments. J Surg Res 206(2):536–542

    Article  PubMed  Google Scholar 

  14. Yen TW, Pezzin LE, Li J et al (2017) Effect of hospital volume on processes of breast cancer care: a National Cancer Data Base study. Cancer 123(6):957–966

    Article  PubMed  Google Scholar 

  15. Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68(1):7–30

    Article  PubMed  Google Scholar 

  16. Boodman SG (2016). Do you need complex surgery? Some doctors may not have much practice. Washington Post

  17. American College of Surgeons. CoC quality of care measures. https://www.facs.org/quality-programs/cancer/ncdb/qualitymeasures

  18. Kaufman CS, Landercasper J (2011) Can we measure the quality of breast surgical care? Ann Surg Oncol 18(11):3053–3060

    Article  PubMed  Google Scholar 

  19. Tomaszewski JJ, Handorf E, Corcoran AT et al (2014) Care transitions between hospitals are associated with treatment delay for patients with muscle invasive bladder cancer. J Urol 192(5):1349–1354

    Article  PubMed  PubMed Central  Google Scholar 

  20. Recht A, Come SE, Henderson IC et al (1996) The sequencing of chemotherapy and radiation therapy after conservative surgery for early-stage breast cancer. N Engl J Med 334(21):1356–1361

    Article  PubMed  CAS  Google Scholar 

  21. Cold S, During M, Ewertz M et al (2005) Does timing of adjuvant chemotherapy influence the prognosis after early breast cancer? Results of the Danish Breast Cancer Cooperative Group (DBCG). Br J Cancer 93(6):627–632

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Hershman DL, Wang X, McBride R et al (2006) Delay in initiating adjuvant radiotherapy following breast conservation surgery and its impact on survival. Int J Radiat Oncol Biol Phys 65(5):1353–1360

    Article  PubMed  Google Scholar 

  23. Lohrisch C, Paltiel C, Gelmon K et al (2006) Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol 24(30):4888–4894

    Article  PubMed  Google Scholar 

  24. Jara Sanchez C, Ruiz A, Martin M et al (2007) Influence of timing of initiation of adjuvant chemotherapy over survival in breast cancer: a negative outcome study by the Spanish Breast Cancer Research Group (GEICAM). Breast Cancer Res Treat 101(2):215–223

    Article  PubMed  Google Scholar 

  25. Yu KD, Huang S, Zhang JX et al (2013) Association between delayed initiation of adjuvant CMF or anthracycline-based chemotherapy and survival in breast cancer: a systematic review and meta-analysis. BMC Cancer 13:240

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Gagliato Dde M, Gonzalez-Angulo AM, Lei X et al (2014) Clinical impact of delaying initiation of adjuvant chemotherapy in patients with breast cancer. J Clin Oncol 32(8):735–744

    Article  PubMed  CAS  Google Scholar 

  27. Chavez-MacGregor M, Clarke CA, Lichtensztajn DY et al (2016) Delayed Initiation of adjuvant chemotherapy among patients with breast cancer. JAMA Oncol 2(3):322–329

    Article  PubMed  PubMed Central  Google Scholar 

  28. Raphael MJ, Biagi JJ, Kong W et al (2016) The relationship between time to initiation of adjuvant chemotherapy and survival in breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 160(1):17–28

    Article  PubMed  CAS  Google Scholar 

  29. Yu KD, Fan L, Qiu LX et al (2017) Influence of delayed initiation of adjuvant chemotherapy on breast cancer survival is subtype-dependent. Oncotarget 8(28):46549–46556

    Article  PubMed  Google Scholar 

  30. Abdel-Rahman O (2018) Impact of timeliness of adjuvant chemotherapy and radiotherapy on the outcomes of breast cancer; a pooled analysis of three clinical trials. Breast 38:175–180

    Article  PubMed  Google Scholar 

  31. McGuire KP, Santillan AA, Kaur P et al (2009) Are mastectomies on the rise? A 13-year trend analysis of the selection of mastectomy versus breast conservation therapy in 5865 patients. Ann Surg Oncol 16(10):2682–2690

    Article  PubMed  Google Scholar 

  32. Balasubramanian BA, Demissie K, Crabtree BF et al (2012) Black Medicaid beneficiaries experience breast cancer treatment delays more frequently than whites. Ethn Dis 22(3):288–294

    PubMed  Google Scholar 

  33. Wilke LG, Czechura T, Wang C et al (2014) Repeat surgery after breast conservation for the treatment of stage 0 to II breast carcinoma: a report from the National Cancer Data Base, 2004–2010. JAMA Surg 149(12):1296–1305

    Article  PubMed  Google Scholar 

  34. Loveland-Jones C, Ruth K, Sigurdson ER et al (2012) Breast conservation in the medicare patient: will the american college of surgeons oncology group Z0011 trial change the pattern of care? Ann Surg Oncol 19s1:S64

    Google Scholar 

  35. Bleicher RJ (2018) Timing and delays in breast cancer evaluation and treatment. Ann Surg Oncol. https://doi.org/10.1245/s10434-018-6615-2

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. Appreciation is extended to Ryan McCabe currently of and Kathleen Thoburn formerly of the American College of Surgeons’ National Cancer Database for their assistance in refining the algorithm for class of case/transfer of care categories utilized herein.

Author information

Authors and Affiliations

  1. Data Working Group, The National Accreditation Program for Breast Centers, American College of Surgeons, Chicago, IL, USA

    Richard J. Bleicher, Lori J. Goldstein, Cary S. Kaufmann, Meena S. Moran, Karen A. Pollitt, David P. Winchester, Lorraine Tafra & Katharine Yao

  2. Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Fox Chase Cancer Center, Room C-308, Philadelphia, PA, 19111, USA

    Richard J. Bleicher

  3. Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA

    Lori J. Goldstein

  4. Biostatistical Core, NorthShore University HealthSystem Research Institute, Evanston, IL, USA

    Cecilia Chang & Chihsiung E. Wang

  5. Bellingham Regional Breast Center, Bellingham, WA, USA

    Cary S. Kaufmann

  6. Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA

    Meena S. Moran

  7. Change Management, American College of Surgeons, Chicago, IL, USA

    Karen A. Pollitt

  8. Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA

    Karen A. Pollitt, Nicholas R. Suss & David P. Winchester

  9. Cancer Programs, American College of Surgeons, Chicago, IL, USA

    David P. Winchester

  10. SUNY Downstate College of Medicine, Brooklyn, NY, USA

    Nicholas R. Suss

  11. Department of Surgery, Northshore University HealthSystem, Evanston, IL, USA

    David P. Winchester & Katharine Yao

  12. Breast Center at Anne Arundel Medical Center, Annapolis, MD, USA

    Lorraine Tafra

Authors
  1. Richard J. Bleicher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cecilia Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chihsiung E. Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lori J. Goldstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cary S. Kaufmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Meena S. Moran
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Karen A. Pollitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nicholas R. Suss
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. David P. Winchester
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Lorraine Tafra
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Katharine Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard J. Bleicher.

Ethics declarations

Conflict of interest

All authors declare no conflicts of interest.

Ethical approval

This research was comprised of de-identified database records of human participants, thus maintaining confidentiality and posing negligible or no risks to the participants within the dataset. This article does not contain any studies with animals performed by any of the authors.

Informed consent

IRB review declared NCDB database review as exempt.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bleicher, R.J., Chang, C., Wang, C.E. et al. Treatment delays from transfers of care and their impact on breast cancer quality measures. Breast Cancer Res Treat 173, 603–617 (2019). https://doi.org/10.1007/s10549-018-5046-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-018-5046-x

Keywords

Search

Navigation