In the latest Annual Cancer Report for St. Cloud Hospital, it is noted that more than 290 women were diagnosed and/or treated at St. Cloud Hospital, the Coborn Cancer Center or had 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 20 CoC approved programs in Minnesota.

Stage at Diagnosis

Minimally Invasive vs. Surgical Breast Biopsy

Breast Conserving Surgery vs. Mastectomy

Survival Rate

National Quality Performance Measures

Stage at Diagnosis

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

Rationale: Women diagnosed with invasive 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: 553 women diagnosed and/or treated for breast cancer from 2009 through 2010 are included in this measure as reported by the St. Cloud Hospital Cancer Registry.

Results: This graph compares the 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.

© 2012 National Cancer Data Base/Commission on Cancer

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 patients who had a breast biopsy at St. Cloud Hospital in 2011 are included in this measure. There were 109 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 national benchmarks.

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 “best practice” with ninety-six percent of women able to have the minimally invasive procedure.

*Benchmark data taken from “Image-Detected Breast Cancer: State of the Art Diagnosis and Treatment”, Journal of the American College of Surgeons-Volume 2008, Issue 4 (October 2009), written by Silverstein, M, .M.D., et al.

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 I to II breast cancer treated surgically at St. Cloud Hospital.

Data Results: Fifty-six percent of the 209 women with stage I to II breast cancer treated surgically at St. Cloud Hospital 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.

*SCH Cases: Only patients receiving surgery at St. Cloud Hospital
© 2012 National Cancer Data Base/Commission on Cancer

Survival Rate

Measure: Five-year observed survival rate is equal to the percent of women alive five years after breast cancer diagnosis. It is important to remember that this is the overall survival rate and not just survival from breast cancer. Women may have died of causes other than breast cancer.

Rationale: Monitoring survival rates is one of many tools used to evaluate the quality of care given by a facility.

Population: Breast cancer patients who were diagnosed and/or treated at St. Cloud Hospital (including CentraCare Radiation Oncology in Alexandria) were included in this data. The diagnostic years, 2003 through 2005, represent the most current data available from the National Cancer Data Base to measure survival rates.

Outcome: St. Cloud Hospital’s five-year observed survival rates for breast cancer compare very favorably with national data.

©2012 National Cancer Data Base (NCDB) / Commission on Cancer (CoC)

National Quality Performance Measures

The St. Cloud Hospital’s cancer program is accredited by the American College of Surgeons Commission on Cancer. 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. 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 three measures for breast cancer with the most current report dated as 2010.

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: All women with breast cancer who were treated with breast conserving surgery at St. Cloud Hospital who were diagnosed in 2010. There were 73 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.

© 2012 Commission on Cancer, American College of Surgeons (ACOS). CP3R Reports. The content reproduced from the applications remains the full and exclusive copyrighted property of the ACOS. The ACOS is not responsible for any ancillary or derivative works based on the original text, tables or figures. Results as of 10/09/2012.

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 II or 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: All women with breast cancer who received part or all of their treatment at St. Cloud Hospital, Coborn Cancer Center or CentraCare Radiation Oncology in Alexandria who were diagnosed in 2010. There were 9 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.

© 2012 Commission on Cancer, American College of Surgeons (ACOS). CP3R Reports. The content reproduced from the applications remains the full and exclusive copyrighted property of the ACOS. The ACOS is not responsible for any ancillary or derivative works based on the original text, tables or figures. Results as of 10/09/2012.

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 II or 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: All women with breast cancer who received part or all of their treatment at St. Cloud Hospital, Coborn Cancer Center or CentraCare Radiation Oncology in Alexandria who were diagnosed in 2010. There were 113 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.

© 2012 Commission on Cancer, American College of Surgeons (ACOS). CP3R Reports. The content reproduced from the applications remains the full and exclusive copyrighted property of the ACOS. The ACOS is not responsible for any ancillary or derivative works based on the original text, tables or figures. Results as of 10/09/2012.

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.