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Full Title: Measuring the Quality of Breast Cancer Care in Women
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Objectives: The purpose of this systematic review was to survey the range of quality measures assessing the quality of breast cancer care in women, and to characterize specific parameters potentially affecting their suitability for wider use. Specific emphasis was placed on diagnosis, treatment (including supportive care), followup, and documentation of this care. Screening and prevention fell outside the review scope. Quality measures quantify adherence to standards of care, or quality indicators (e.g., percentage of women receiving radiotherapy after breast-conserving surgery), and can vary in terms of the extent of their scientific development.
Data Sources: MEDLINE®, Cancerlit, Healthstar, PreMEDLINE®, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness, Cochrane Central Register of Controlled Trials, and Health and Psychosocial Instruments. Search elements included: diagnosis and treatment of breast cancer; quality measures; systematic reviews; clinical practice guidelines; and, commentaries or editorials. Manual searches of reference lists of included studies, review articles, and Web sites were conducted. the American Society of Clinical Oncology (ASCO) contributed quality measures currently under development.
Review Methods: Studies of evidence-based quality measures evaluating adherence to standards of breast cancer care were included. The population of interest was female adults diagnosed with, or in treatment for, any histological type of adenocarcinoma of the breast, including both in situ and invasive cancer. Three levels of screening, with two reviewers at each level, were employed. Disagreements between reviewers were resolved by forced consensus and, if necessary, third party intervention. Three reviewers independently abstracted data (i.e., characteristics of the report, study, population, quality indicators used in quality measurement, and adherence rate), and then checked each other's work. A scheme was developed and applied independently by two assessors, to examine the scientific development of each quality measure.
Results: Sixty relevant reports identified 58 studies and 143 quality indicators used to measure the quality of breast cancer care. Measures reflecting processes of care were the most frequently evaluated. Not all predefined types of care were assessed using quality measures. Only a qualitative synthesis was undertaken, given the virtual lack of scientifically developed quality measures (n = 12). Most of these assessed patient-reported quality of life.
Conclusions: While some studies revealed patterns of underuse of care, these and all other adherence data require confirmation using scientifically validated quality measures. Current attempts by ASCO to formally develop a set of quality measures relating to breast cancer care may hold the key to conducting these definitive studies.
Measuring the Quality of Breast Cancer Care in Women
Evidence-based Practice Center: University of Ottawa Evidence-based Practice Center
Topic Nominators: Centers for Medicare & Medicaid Services (CMS); Centers for Disease Control and Prevention (CDC); National Cancer Institute, National Institute of Health (NIH)
Current as of October 2004