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Breast Cancer Quality Measures

Annually, more than 250 women are diagnosed and/or treated at St. Cloud Hospital, the Coborn Cancer Center or receive radiation at CentraCare Radiation Oncology in Alexandria, Minnesota. Information on the care and outcome of all cancer patients diagnosed and/or treated in these facilities is reported by the St. Cloud Hospital Cancer Registry. The professionals providing breast cancer care are committed to maintaining information about outcomes for patients treated in the cancer program. Information from the registry enables these professionals to analyze the patterns and quality of breast cancer care to improve cancer treatment.

The National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines, National Cancer Data Base (NCDB), Advisory Board Oncology Roundtable and peer-reviewed journals were used to identify the measures and establish benchmarks for evaluating quality breast cancer care. The NCDB, a joint program of the Commission on Cancer (CoC) and the American Cancer Society, is a nationwide oncology outcomes database for more than 1,500 CoC approved cancer programs in the United States and Puerto Rico. This includes 27 CoC approved programs in Minnesota.

Stage at Diagnosis

Measure: American Joint Committee on Cancer (AJCC) Stage at Diagnosis

Rationale: Women diagnosed with breast cancer at an early stage have a better overall survival rate. Early stage diagnosis depends upon participation in screening, i.e. annual mammography and clinical breast exam. Another contributing factor in early diagnosis is the availability of technology such as breast magnetic resonance imaging (MRI), digital mammography and specialized, experienced breast care providers.

Population: 267 patients treated for breast cancer in 2012 are included in this measure as reported by the St. Cloud Hospital Cancer Registry.
Results: This graph compares stage at diagnosis for St. Cloud Hospital Registry breast cancer patients to state and national statistics from the National Cancer Data Base (NCDB).

Outcome: Stage at diagnosis for breast cancer cases reported by St. Cloud Hospital compares favorably to data submitted to the National Cancer Data Base by hospitals in Minnesota and the nation.

 © 2014 National Cancer Data Base/Commission on Cancer

National Quality Performance Measures

St. Cloud Hospital’s cancer program is accredited by the American College of Surgeons Commission on Cancer (CoC). The Commission has partnered with the National Quality Forum (NQF), American Society for Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) to provide accredited cancer programs with performance measures and comparison data on an annual basis as a method to assess quality of care.

The aggregated, comparative information is provided in the following data groups:

1.  The American Cancer Society Division (ACS) Midwest: Data from CoC approved programs in Iowa, Minnesota, South Dakota, and Wisconsin.

2. Census Region West North Central: Data from CoC approved programs in Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota.

3. CoC Program Type, Community Hospital Comprehensive Cancer Program (COMP): Data from CoC approved programs across the nation which sees 650 or more newly diagnosed cancer cases each year and provides a full range of diagnostic and treatment services that are available on site or by referral.

4. Data from Minnesota CoC approved cancer programs.

5. Data from all CoC approved programs across the country.

It is important to remember that every patient is unique and there may be clinical reasons why a recommended treatment is not the best treatment for the individual. There are currently six measures for breast cancer with the most current report dated as of 2012.

Minimally Invasive vs. Surgical Breast Biopsy

Measure: Percent of patients receiving minimally invasive (stereotactic or ultrasound) biopsy versus surgical biopsy.

Rationale: Stereotactic and ultrasound biopsies are considered to be minimally invasive. Minimally invasive breast biopsies ensure optimal patient management. Their accuracy is equal to that of open breast biopsies and is the optimal initial tissue-attainment procedure for image-detected breast abnormalities. These biopsies take less time to perform, cause less patient discomfort and cosmetic deformity, result in fewer artifacts on subsequent mammography, and are more cost effective than surgical biopsies.

Population: All breast cancer patients who had a breast biopsy at St. Cloud Hospital from 2010 to 2012 are included in this measure. There were 389 patients as reported by the Cancer Registry.

Data Results: This graph depicts the percentage of patients undergoing stereotactic or ultrasound biopsies (minimally invasive biopsies) at St. Cloud Hospital compared with state and national data.

Outcome: Not all women are candidates for minimal invasive biopsy procedures. However with the latest technology and experienced professionals, St. Cloud Hospital compares favorably to state and national data.

* Benchmark: Performance Rate ≥ 80% OR Upper Bound of the 95% CI ≥ 80% © 2014 National Cancer Data Base/Commission on Cancer. Results as of 12/15/2014.

 

Breast Conserving Surgery

Measure: Breast Conserving Surgery vs. Mastectomy

Rationale: A diagnosis of early stage breast cancer offers a variety of treatment options beginning with surgery – mastectomy versus breast conserving surgery. Research shows women with early stage breast cancer treated with breast conserving surgery plus radiation therapy were as likely to be alive and disease-free 20 years later as women treated with mastectomy.

Population: Women with stage 0 to II breast cancer treated surgically at St. Cloud Hospital.

Data Results: 252 of the 415 women with stage 0 to II breast cancer treated surgically at St. Cloud Hospital from 2010 to 2012 had breast conserving surgery. This compares well with Minnesota and national statistics.

Outcome: St. Cloud Hospital’s breast conserving surgery rates compare favorably to state and national data.

No benchmarks at this time. © 2014 National Cancer Data Base/Commission on Cancer. Results as of 12/15/2014.

 

Breast Conserving Surgery/Radiation Therapy (BCS/RT)

BCS/RT Measure: Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70 receiving breast conserving surgery (lumpectomy) for invasive breast cancer.

One year is identified as a measure to allow for medical intervention following surgery. Most often radiation therapy is delivered within one to six months of surgery. Radiation treatment should start as soon as medically feasible.

Rationale: To compare the care of breast cancer patients at St. Cloud Hospital to other Commission on Cancer accredited cancer programs in Minnesota and nationally.

Population: Female breast cancer patients who were diagnosed in 2010 to 2012, were treated with breast conserving surgery, and underwent part or all of their treatment at St. Cloud Hospital, Coborn Cancer Center, and/or CentraCare Radiation Oncology in Alexandria. There were 222 patients as reported by the St. Cloud Hospital Cancer Registry undergoing this surgery.

Outcome: St. Cloud Hospital’s results compare very favorably with other accredited cancer programs in Minnesota and nationally.

*CoC Benchmark: Performance Rate ≥ 90% OR Upper Bound of the 95% Confidence Interval ≥ 90%. © 2014 National Cancer Data Base/Commission on Cancer. Results as of 12/15/2014.

 

Multi-Agent Chemotherapy (MAC) Treatment for Estrogen Receptor Negative Breast Cancer

MAC Measure: Multi-agent chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1cN0M0, or Stage IB to III hormone receptor negative breast cancer.

Rationale: To compare the care of breast cancer patients at St. Cloud Hospital to other Commission on Cancer accredited cancer programs in Minnesota and nationally.

Population: Female breast cancer patients who were diagnosed in 2010 to 2012 and received part or all of their treatment at St. Cloud Hospital, Coborn Cancer Center or CentraCare Radiation Oncology in Alexandria. There were 34 patients as reported by the St. Cloud Hospital Cancer Registry.

Outcome: St. Cloud Hospital’s results compare favorably with other accredited cancer programs in Minnesota and nationally.

*CoC Benchmark: Performance Rate ≥ 90% OR Upper Bound of the 95% Confidence Interval ≥ 90%. © 2014 National Cancer Data Base/Commission on Cancer. Results as of 12/15/2014.


Hormone Therapy (HT) for Estrogen Receptor Positive Breast Cancer

HT Measure: Tamoxifen or third generation aromatase inhibitor is considered or administered within 1 year (365 days) of diagnosis for women with AJCC T1cN0M0, or Stage IB to III hormone receptor positive breast cancer.

Rationale: To compare the care of breast cancer patients at St. Cloud Hospital to other Commission on Cancer accredited cancer programs in Minnesota and nationally.

Population: Female breast cancer patients who were diagnosed in 2010 to 2012 and received part or all of their treatment at St. Cloud Hospital, Coborn Cancer Center or CentraCare Radiation Oncology in Alexandria. There were 351 cases as reported by the St. Cloud Hospital Cancer Registry.

Outcome: St. Cloud Hospital’s results compare favorably with other accredited cancer programs in Minnesota and nationally.

*CoC Benchmark: Performance Rate ≥ 90% OR Upper Bound of the 95% Confidence Interval ≥ 90%. © 2014 National Cancer Data Base/Commission on Cancer. Results as of 12/15/2014.

 

Mastectomy/Radiation Therapy for Women with Four or More Positive Lymph Nodes (MASTRT)

MASTRT Measure: Radiation therapy is considered or administered following any mastectomy within 1 year (365 days) of diagnosis of breast cancer for women with ≥ 4 positive regional lymph nodes.

One year is identified as a measure to allow for medical intervention following surgery. Most often radiation therapy is delivered within one to six months of surgery. Radiation treatment should start as soon as medically feasible.

Rationale: To compare the care of breast cancer patients at St. Cloud Hospital to other Commission on Cancer accredited cancer programs in Minnesota and nationally.

Population: Female breast cancer patients, who were diagnosed in 2010 to 2012, were treated with mastectomy, were found to have four or more positive lymph nodes, and underwent part or all of their treatment at St. Cloud Hospital, Coborn Cancer Center, and/or CentraCare Radiation Oncology in Alexandria. There were 34 patients as reported by the St. Cloud Hospital Cancer Registry.

Outcome: St. Cloud Hospital’s results compare very favorably with other accredited cancer programs in Minnesota and nationally.

*CoC Benchmark: Performance Rate ≥ 90% OR Upper Bound of the 95% Confidence Interval ≥ 90%. © 2014 National Cancer Data Base/Commission on Cancer. Results as of 12/15/2014.

Additional Resources

Learn more about the services provided by the St. Cloud Hospital Breast Center

For more information about any of the quality measures above, please contact the St. Cloud Hospital Cancer Registry at 320-229-4907.

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