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Breast Cancer Res Treat. 2019 Feb;173(3):603-617. doi: 10.1007/s10549-018-5046-x. Epub 2018 Nov 15.

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

Author information

1
Data Working Group, The National Accreditation Program for Breast Centers, American College of Surgeons, Chicago, IL, USA. richard.bleicher@fccc.edu.
2
Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Fox Chase Cancer Center, Room C-308, Philadelphia, PA, 19111, USA. richard.bleicher@fccc.edu.
3
Biostatistical Core, NorthShore University HealthSystem Research Institute, Evanston, IL, USA.
4
Data Working Group, The National Accreditation Program for Breast Centers, American College of Surgeons, Chicago, IL, USA.
5
Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
6
Bellingham Regional Breast Center, Bellingham, WA, USA.
7
Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA.
8
Change Management, American College of Surgeons, Chicago, IL, USA.
9
Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA.
10
SUNY Downstate College of Medicine, Brooklyn, NY, USA.
11
Cancer Programs, American College of Surgeons, Chicago, IL, USA.
12
Department of Surgery, Northshore University HealthSystem, Evanston, IL, USA.
13
Breast Center at Anne Arundel Medical Center, Annapolis, MD, USA.

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.

KEYWORDS:

Breast cancer; Delays; Quality measures; Second opinions; Transfers of care

PMID:
30443881
DOI:
10.1007/s10549-018-5046-x

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