Katharine Yao

To address the interval between biopsy and first treatment, the National Accreditation Program for Breast Centers (NAPBC) launched Patient-Reported Observations for Medical Procedure Timeliness (PROMPT), a quality collaborative. Participating PROMPT sites submitted data on the number of days from biopsy to first treatment (either surgery or neoadjuvant treatment (NAC)) before and after individual site-specific quality improvement (QI) projects using the American College of Surgeons Quality Framework. The study examined interventions of sites that reported successful projects and barriers for both successful and unsuccessful sites. Of 104 PROMPT sites, 62 (59.6 %) examined the time from biopsy to surgery, and 42 (40.4 %) analyzed the time from biopsy to NAC. Overall, 56 (53.8 %) sites decreased their interval from biopsy to treatment, from 50.3 to 38.8 days for biopsy to surgery and from 40.7 to 30.9 days for biopsy to NAC. No facility factors were associated with successfully decreasing this interval. The most common intervention for both intervals was enabling navigators to schedule appointments for surgeons and medical oncologists. Of 22 interventions for the interval from biopsy to surgery, the most common included hiring a breast surgeon and increasing operating room (OR) block time for surgeons. Of 17 interventions for the interval from biopsy to NAC, the most common were streamlining port-a-cath placements, ordering staging studies before seeing medical oncology, and offering concurrent medical oncology and surgery appointments. Just more than half of the PROMPT sites improved their interval. Interventions to improve timely care include hiring staff and improving scheduling.

Surgical volumes have long been correlated with outcomes, but their relationship to quality measures (QMs) remains unclear. This study aimed to examine the association between surgeon volumes and American Society of Breast Surgeons QM performance. The study analyzed 635,252 women in the National Cancer Database 18 years old or older with stage I, II, or III breast cancer who underwent surgery between 1 January 2018 and 31 December 2022. Surgeon volume was calculated as tertiles using National Provider Identifiers. Quality measures included treatment timeliness, axillary management, and multidisciplinary care. Adjusted multilevel logistic models, with hospital as a random effect, were used to investigate associations of volume with QM performance. Low-volume (LV), average-volume (AV), and high-volume (HV) surgeons annually performed a median of 33 (interquartile range [IQR], 17-48), 98 (IQR, 80-112), and 169 (IQR, 147-202) breast cancer surgeries, respectively. Low-volume surgeons cared for a higher proportion of older, non-white, and non-metropolitan patients and were more likely to provide timely surgery (odds ratio [OR], 1.12; 95 % confidence interval [CI], 1.09-1.14), but less likely to adhere to adjuvant radiotherapy (odds ratio [OR], 0.81; 95 % confidence interval [CI], 0.77-0.85), appropriate axillary management (OR, 0.65; 95 % CI, 0.57-0.74), and sentinel lymph node biopsy (SLNB) omission (OR, 0.69; 95 % CI, 0.65-0.73). For LV surgeons, breast center accreditation was associated with increased radiotherapy referral (OR, 1.28; 95 % CI, 1.14-1.44) and SLNB omission (OR, 1.47; 95 % CI, 1.23-1.76). Low-volume surgeons had greater variability in breast QM performance and may benefit from efforts, including education and strengthening multidisciplinary communication, to improve breast cancer care for vulnerable populations.

PURPOSE: The National Accreditation Program for Breast Centers (NAPBC) launched the Patient-Reported Observations for Medical Procedure Timeliness quality collaborative to assess time intervals between screening and treatment for patients with breast cancer. METHODS: Sites submitted monthly timeliness data in calendar days from 2019 to 2021 along with their perceptions of timeliness at their centers and facility characteristics. All patients were included in the interval from screening to diagnosis, whereas only patients with cancer were included in the biopsy to treatment intervals. Institutions were compared and assessed for differences and associations with center characteristics via the Kruskal-Wallis test. RESULTS: Three hundred seventy-three (64.5%) NAPBC-accredited breast centers enrolled, and 311 (83.3%) provided complete timeliness metrics. Two hundred nine (56%) sites did not have trainees, 154 (41.3%) sites were within 10 miles of a major city, and the median number of annual breast cancer cases was 280 (IQR, 189-366). From 2019 to 2021, the time between diagnosis and treatment was as follows: 11-12 days between screening mammogram (MGM) and diagnostic MGM, 8-9 days between diagnostic MGM and biopsy, 32-34 days between biopsy and neoadjuvant therapy, and 39-42 days between biopsy and surgery. The enrolled centers believe that these intervals should be 7, 7, 21, and 28 days, respectively. Higher annual case volume and a larger number of surgeons exclusively devoted to breast disease were significantly associated with longer time intervals. CONCLUSION: Time from biopsy to first treatment is longer than that centers expected compared with time from screening to diagnosis. There is significant variability across NAPBC in time from screening mammogram to treatment, and some institutions will face more challenges with timely quality measures than others. Further investigation into whether these differences confer outcome differences should be pursued.

Purpose We examined the impact of the COVID-19 consortium recommendations on the surgical management of breast cancer during the first year of the pandemic. Methods Patients with newly diagnosed ER + DCIS, ER- DCIS, AJCC Stage cT1-2N0-1 ER + , HER2-, HER2 + , and triple negative breast cancer were identified from the National Cancer Database from 2018 to 2021. An interrupted time series design evaluated differences in surgical delay and use of neoadjuvant chemotherapy/immunotherapy (NAC) and endocrine therapy (NET) before and after the pandemic. Results A total of 895116 female patients were included in the study with a mean age of 61.7 years. Time to surgery decreased by an average 5.5 days from January 2020 to May 2020 for all breast cancer types, corresponding with a 62.2% decrease in breast cancer diagnoses per month from January 2020 to April 2020. The use of NET increased from 5.6 to 23.6% from January to March 2020 for patients with ER + DCIS and 8.0 to 31.1% for ER + cT1-2N0 cancer (both p < 0.01). The use of NAC for HER2 + tumors and triple negative breast cancers has been increasing since 2018 and a larger than expected increase was seen from 57.2 to 63.6% for HER2 + tumors and 55.6 to 68.7% for triple negative breast cancers (both p < 0.01). Treatment practices returned to pre-pandemic levels in June 2020. Conclusion Prior to the publication of the Consortium recommendations, time to surgery decreased while the use of NET and NAC increased, with the resumption of pre-pandemic practices by June 2020.