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Observational Study
. 2017 Jul 15;123(14):2618-2625.
doi: 10.1002/cncr.30660. Epub 2017 Mar 13.

Using the National Cancer Data Base for quality evaluation to assess adherence to treatment guidelines for nonmetastatic inflammatory breast cancer

Heather Y Lin  1 , Isabelle Bedrosian  2 , Gildy V Babiera  2   3 , Simona F Shaitelman  4 , Henry M Kuerer  2 , Wendy A Woodward  4 , Naoto T Ueno  3   5 , Yu Shen  1
Affiliations
Observational Study

Using the National Cancer Data Base for quality evaluation to assess adherence to treatment guidelines for nonmetastatic inflammatory breast cancer

Heather Y Lin et al. Cancer. .

Abstract

Background: Guidelines for the treatment of nonmetastatic inflammatory breast cancer (IBC) using trimodality therapy (TT) (chemotherapy, surgery, and radiotherapy) have remained largely unchanged since 2000. However, many patients with nonmetastatic IBC do not receive TT. It is unknown how patient-level (PL) and facility-level (FL) factors contribute to TT use.

Methods: Using the National Cancer Data Base, patients with nonmetastatic IBC who underwent locoregional treatment from 2003 through 2011 were identified. The authors correlated PL factors, including demographic and tumor characteristics, with TT use. An observed-to-expected ratio for the number of patients treated with TT was calculated for each hospital by adjusting for significant PL factors. Hierarchical mixed effects models were used to assess the percentage of variation in TT use attributable to PL and FL factors, respectively.

Results: Of the 542 hospitals examined, 55 (10.1%) and 24 (4.4%), respectively, were identified as significantly low and high outliers for TT use (P<.05). The percentage of the total variance in the use of TT attributable to the facility (11%) was nearly triple the variance attributable to the measured PL factors (3.4%). The nomogram generated from multivariate logistic regression of PL factors only allows a facility to assess TT use given their PL data.

Conclusions: FL factors rather than PL factors appear to contribute disproportionately to the underuse of TT in patients with nonmetastatic IBC. To improve treatment guideline adherence for patients with nonmetastatic IBC, it is critical to identify the specific FL factors associated with TT underuse. More organized FL intervention is required to train physicians and to build multidisciplinary teams. Cancer 2017;123:2618-25. © 2017 American Cancer Society.

Keywords: adherence to treatment guidelines; facility-level factors; nonmetastatic inflammatory breast cancer (IBC); patient- and facility-level factors; trimodality treatment.

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Conflict of interest statement

None of the authors have conflict of interest.

Figures

Figure 1
Figure 1
Figure 1a. Ratio of observed to expected (O/E) number of patients receiving trimodality therapy. Blue circles are hospitals with O/E significantly < 1; orange circles are hospitals with O/E significantly > 1. Circle size is proportional to volume of patients with nonmetastatic IBC treated at that facility. Figure 1b. Percentage of significantly low and high outliers for trimodality therapy use for nonmetastatic IBC by facility type and facility location
Figure 1
Figure 1
Figure 1a. Ratio of observed to expected (O/E) number of patients receiving trimodality therapy. Blue circles are hospitals with O/E significantly < 1; orange circles are hospitals with O/E significantly > 1. Circle size is proportional to volume of patients with nonmetastatic IBC treated at that facility. Figure 1b. Percentage of significantly low and high outliers for trimodality therapy use for nonmetastatic IBC by facility type and facility location
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