Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan;197(1):211-221.
doi: 10.1007/s10549-022-06796-w. Epub 2022 Nov 9.

Development of a key performance indicator for breast cancer in Queensland, Australia

Euan T Walpole  1   2   3 , Philippa H Youl  4 , Julie Moore  4 , Michelle Morris  5 , Danica Cossio  4 , Pardeep Dhanda  4 , David E Theile  6   4   7 , Shoni Philpot  4
Affiliations

Development of a key performance indicator for breast cancer in Queensland, Australia

Euan T Walpole et al. Breast Cancer Res Treat. 2023 Jan.

Abstract

Purpose: Using population-based data for women diagnosed with stage I-III breast cancer, our aim was to examine the impact of time to treatment completion on survival and to identify factors associated with treatment delay.

Methods: This retrospective study used clinical and treatment data from the Queensland Oncology Repository. Time from diagnosis to completing surgery, chemotherapy and radiation therapy identified a cut-off of 37 weeks as the optimal threshold for completing treatment. Logistic regression was used to identify factors associated with the likelihood of completing treatment > 37 weeks. Overall (OS) and breast cancer-specific survival (BCSS) were examined using Cox proportional hazards models.

Results: Of 8279 women with stage I-III breast cancer, 31.9% completed treatment > 37 weeks. Apart from several clinical factors, being Indigenous (p = 0.002), living in a disadvantaged area (p = 0.003) and receiving ≥ two treatment modalities within the public sector (p < 0.001) were associated with an increased likelihood of completing treatment > 37 weeks. The risk of death from any cause was about 40% higher for women whose treatment went beyond 37 weeks (HR 1.37, 95%CI 1.16-1.61), a similar result was observed for BCSS. Using the surgery + chemotherapy + radiation pathway, a delay of > 6.9 weeks from surgery to starting chemotherapy was significantly associated with poorer survival (p = 0.001).

Conclusions: Several sociodemographic and system-related factors were associated with a greater likelihood of treatment completion > 37 weeks. We are proposing a key performance indicator for the management of early breast cancer where a facility should have > 90% of patients with a time from surgery to adjuvant chemotherapy < 6.9 weeks.

Keywords: Breast cancer; Management; Survival; Treatment.

PubMed Disclaimer

Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
a Five-year overall survival by time to treatment completion b Five-year breast cancer-specific survival by time to treatment completion
Fig. 2
Fig. 2
Proportion of women experiencing delay to start chemotherapy following surgery
Fig. 3
Fig. 3
a Funnel plot of surgery → chemotherapy → radiation delay > 37 weeks by treatment site and site volume. b Funnel plot of surgery → chemotherapy delay by treatment site and site volume
See this image and copyright information in PMC

References

    1. Cancer Alliance Queensland (2021) Cancer in Queensland: A Statistical Overview 1982–2031, Annual update 2017. Queensland Health. https://cancerallianceqld.health.qld.gov.au. Accessed 27 Oct 2022
    1. Walpole ET, Theile DE, Philpot S, Youl PH, for Cancer Alliance Q Development and implementation of a cancer quality index in Queensland, Australia: a tool for monitoring cancer care. J Oncol Pract. 2019;15:e636–e643. doi: 10.1200/JOP.18.00372. - DOI - PubMed
    1. Queensland Health (2020) The Partnership. Retrieved from Cancer Alliance Queensland. https://cancerallianceqld.health.qld.gov.au/cancer-alliance-queensland/. Accessed 27 Oct 2022
    1. Queensland Health (2020) Terms of Reference. Cancer Alliance Queensland: https://cancerallianceqld.health.qld.gov.au/media/1887/terms-of-referenc.... Accessed 27 Oct 2022
    1. Brazda A, Estroff J, Euhus D, Leitch AM, Huth J, Andrews V, Moldrem A, Rao R. Delays in time to treatment and survival impact in breast cancer. Ann Surg Oncol. 2010;17(Suppl 3):291–296. doi: 10.1245/s10434-010-1250-6. - DOI - PubMed