Breast and Colorectal Cancer Patients Receiving High-Quality Care
According to a study of patients with stage I to stage III breast cancer or stage II to stage III colorectal cancer, a large majority of patients are receiving care that is in accordance with current guidelines. These results were published in the Journal of Clinical Oncology.
A 1999 report from on the quality of cancer care, published by the National Cancer Policy Board of the Institute of Medicine, concluded that “some individuals with cancer do not receive care known to be effective for their condition.” The report noted that the extent of the problem was uncertain due to limited information about the patterns of cancer care.
To describe the quality of care received by patients with breast or colorectal cancer, researchers from the Harvard School of Public Health and the RAND Corporation conducted a study among 1,765 patients.Patients were identified from hospital cancer registries in five areas of the US: Atlanta, GA; Cleveland, OH; Houston, TX; Kansas City, KS; and Los Angeles, CA. Patients were eligible if they had stage I to stage III breast cancer or stage II to stage III colorectal cancer; they were between the ages of 21 and 80.
Information about patient care was collected by patient survey as well as medical record review. The patient survey was conducted roughly four years after diagnosis. The survey included questions about the patients’ initial therapy and experiences, symptoms, and quality of life. Information collected from review of the patients’ medical records included tumor characteristics, referrals, decision making, cancer treatment, and other health problems.
Based on a review of existing quality indicators, guidelines, review articles, and randomized clinical trials, the researchers developed a set of 36 quality measures for breast cancer and 25 quality measures for colorectal cancer. These quality measures addressed five general areas of care: diagnostic evaluation; surgery; adjuvant therapy; management of treatment toxicity; and post-treatment surveillance. As an example, a quality measure related to adjuvant therapy for breast cancer stated “IF a patient with stage I to stage III breast cancer has breast-conserving surgery, THEN the patient should receive local radiation therapy.”
Results suggest that adherence to the quality measures was high but not perfect:
- Breast cancer patients received 86% of recommended care.
- Colorectal cancer patients received 78% of recommended care.
- Adherence varied by quality measure and by geographic region. For example, although most patients received chemotherapy when indicated, chemotherapy dose was often not consistent with guidelines.
The researchers conclude that initial treatment of patients with breast or colorectal cancer is generally consistent with current recommendations. Because adherence to quality measures was not uniformly high for all measures and all geographic regions, however, the researchers note that there is room for improvement.
 Hewitt M, Simone J: National Cancer Policy Board, Institute of Medicine: Ensuring Quality Cancer Care. Washington, DC, National Academy Press 1999.
Malin JL, Schneider EC, Epstein AM et al. Results of the National Initiative for Cancer Care Quality: How Can We Improve the Quality of Cancer Care in the United States. Journal of Clinical Oncology . 2006;24:626-634.
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