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2016 Cancer Annual Report

2016 - Public Report of Outcomes

Topic: Breast Cancer Quality Measures

By providing the exact care a breast cancer patient needs and delivering it in a timely manner better outcomes can be achieved. The exact care needed is defined by treatment guidelines that take into consideration the stage of disease and certain prognostic indicators to determine the best course of treatment.

As a Commission on Cancer accredited cancer program, the Fremont Health Medical Center has information technology tools called Cancer Program Practice Profile reports. These tools are electronic documents which measure the rate of adherence to the guidelines and enable healthcare providers to evaluate and improve the quality of cancer care that is provided. The measurements that these tools provide can verify that treatment is adhering to the guidelines and assure patients that the best possible care is being provided.

Quality Measure Reports for Breast Cancer Treated at Fremont Health Medical Center

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Surgery

BCSRT:
For women selecting beast conserving surgery, radiation therapy is an important and integral part of the treatment process. Studies have determined that radiation therapy significantly reduces the risk of local recurrence of the breast cancer following lumpectomy. The guideline that defines this treatment process therefore requires that radiation therapy be administered to all women who undergo a lumpectomy to reduce the risk of local recurrence and achieve an outcome that is comparable to a mastectomy.

The largest individual trial evaluating the use of radiation after breast conservation surgery was the NSABP B-06 trial. The 12-year actuarial local recurrence data from this trial revealed an ipsilateral breast recurrence rate of 35% in the lumpectomy-alone group compared to 10% in the lumpectomy plus radiation group.(1)

Fremont Health Medical Center Performance Results

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Adjuvant Therapy

Outcomes for breast cancer patients are also improving because of the routine use of better adjuvant treatments after surgery. These adjuvant treatments include the use of hormone therapy, combination chemotherapy and radiation therapy following mastectomy for advanced stages of disease. Each of these therapies are part of established treatment guidelines that are used in the treatment of breast cancer.

HT:
There are several classes of drugs that reduce the growth stimulating effect of estrogen on cancer cells. Numerous clinical trials have consistently demonstrated the beneficial effect of the drugs for breast cancer patients. These benefits are demonstrated by significantly reduced risk of recurrence of the cancer, death from cancer, and a reduced risk of developing a separate cancer in the opposite breast. These benefits continue for many years after the medication is stopped. (2)

Fremont Health Medical Center Performance Results

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MAC:
Multiple drug chemotherapy treatments are indicated for breast cancer patients whose tumors would not respond to hormone therapy because they lack certain receptors. These drug regimens have been developed through numerous clinical trials and are currently well established with proven survival benefits. The most recent meta-analysis of randomized trials showed that for patients aged 50 to 69 years with ER-negative tumors and not receiving tamoxifen, the reduction in the risk of recurrence due to any kind of polychemotherapy was 33%; and for mortality it was 26%. (3)

Fremont Health Medical Center Performance Results

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MSTRT:
The recommended surgery for breast cancer patients with stage 3 disease is usually mastectomy. For those patients with stage 3 disease who have 4 or more lymph nodes with metastatic disease, adjuvant radiation provides significant benefits and is an integral part of the guideline used to plan their treatment. Administering  radiation therapy to breast cancer patients with 4 or more positive lymph nodes improves outcomes by reducing the risk of local recurrence of the cancer and also improves survival rates. (5)

A meta-analysis published in an article in Lancet, 2014, demonstrated that radiation therapy following a mastectomy for breast cancer patients with 4 or more positive lymph nodes radiotherapy reduced locoregional recurrence), overall recurrence, and breast cancer mortality. In the 1,772 women with breast cancer in four or more lymph nodes, radiation after mastectomy reduced risk of recurrence 21% and improved the survival rate 13%.

Fremont Health Medical Center Performance Results

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Analysis

For each breast cancer patient treated at Fremont Health these tools assure that their treatment plans contained the essential steps required to meet the specific needs of their particular disease process and achieve the best possible outcome.

Bibliography

  1. NEJM 1995; 333:1456-1461
  2. West J Med 2001;174(4):284-287
  3. Lancet 2005;365:1687-1717 and JAMA 2006 Apr 12;295(14):1658-67
  4. JNCI (2004) 96 (24): 1823-1831
  5. Lancet 2014 Jun 21;383(9935):2127-35