Breast cancer: Global quality care

2019 ◽  
Keyword(s):  
Breast Cancer ◽  
Best Practices ◽  
Cancer Care ◽  
Care Pathway ◽  
Health Care Systems ◽  
Quality Care ◽  
Breast Cancer Patients ◽  
Breast Cancer Care ◽  
Global Quality ◽  
Care Systems

Caregivers delivering care to breast cancer patients wish to provide the highest quality breast care possible. Due to the complexity of the care pathway, this care should be delivered by a multidisciplinary team working in a breast cancer unit/centre. This book was written by experts from different disciplines and presents ideas for developing a breast unit wherever you live. The authors provide thorough descriptions of high-quality breast cancer care, define targets, methods to assess one’s care, and ideas on how to improve care within one’s resources. A global view of the quality of breast cancer care shows specific best practices applicable to many centres operating in various health care systems with different financial and political situations. Foundation hallmarks of innovation, communication, patient-centred care, multidisciplinary, and budget considerations guide specific recommendations for each component of care. This book discusses global and local considerations so that optimally ‘integrated’ breast cancer care can be organized. Each component of care (e.g. imaging, surgery, etc.) is discussed from both theoretical and practical aspects. The recommendation for each component of care is facilitated by experienced experts laying out rational and practical approaches to each step. This book provides guidance how to integrate the different disciplines into breast cancer care. Beyond treatment, it provides practical considerations regarding accreditation and certification, and it comments on the influence of budget and of treatment. Finally, it demonstrates how best practices may be altered by the emerging involvement of patients, technologies, and transitions of future societal values.

What Are the Ethical Implications of Understanding and Treating Breast Cancer?

2018 ◽  
Author(s):  
Mary Ann G. Cutter
Keyword(s):  
Breast Cancer ◽  
Risk Assessment ◽  
Informed Consent ◽  
Cancer Care ◽  
The United States ◽  
Breast Cancer Patients ◽  
Breast Cancer Care ◽  
Ethical Implications ◽  
Personalized Approach ◽  
Limit Access

Philosophically speaking, the question “What are the ethical implications of understanding breast cancer?” raises a host of issues, including informed consent, risk assessment, and access to breast cancer care. What we find is that, initially, there are adequate guidelines for informed consent, adequate efforts to develop risk assessment measures, and a decent level of access to breast cancer care in the United States. But things can be improved from an ethical standpoint. Upon reflection, the informed consent process would benefit from a more explicit discussion of uncertainty in breast cancer medicine and the ways breast cancer patients make decisions about their care. Risk assessments would benefit from a more personalized approach. Access to breast cancer care could be improved by continued studies of the diverse forces that limit access to proper breast cancer care.

Understanding Disparities in Breast Cancer Care in Memphis, Tennessee

2018 ◽  
Vol 84 (5) ◽  
pp. 620-627 ◽  
Author(s):  
Elena P. Lamb ◽  
F. Elizabeth Pritchard ◽  
Simonne S. Nouer ◽  
Elizabeth A. Tolley ◽  
Brandon S. Boyd ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Confidence Interval ◽  
Cancer Patients ◽  
Cancer Care ◽  
White Women ◽  
Clinical Stage ◽  
Breast Cancer Patients ◽  
Breast Cancer Care ◽  
Black Patients ◽  
White Patients

Although significant progress has been made in improving breast cancer survival, disparities among racial, ethnic, and underserved groups still exist. The goal of this investigation is to quantify racial disparities in the context of breast cancer care, examining the outcomes of recurrence and mortality in the city of Memphis. Patients with a biopsy-proven diagnosis of breast cancer from January 1, 2002, through December 31, 2012, were obtained from the tumor registry. Black patients were more likely to have advanced (II, III, or IV) clinical stage of breast cancer at diagnosis versus white patients. Black breast cancer patients had a two times higher odds of recurrence (95% confidence interval: 1.4, 3.0) after adjusting for race and clinical stage. Black breast cancer patients were 1.5 times more likely to die (95% confidence interval: 1.2, 1.8), after adjusting for race; age at diagnosis; clinical stage; ER, PR, HER2 status; and recurrence. Black women with stages 0, I, II, and III breast cancer all had a statistically significant longer median time from diagnosis to surgery than white women. Black patients were more likely to have advanced clinical stages of breast cancer at diagnosis versus white patients on a citywide level in Memphis. Black breast cancer patients have higher odds of recurrence and mortality when compared with white breast cancer patients, after adjusting for appropriate demographic and clinical attributes. More work is needed to develop, evaluate, and disseminate interventions to decrease inequities in timeliness of care for breast cancer patients.

Quality of care for breast cancer patients in Japan: An analysis of the Japanese Breast Cancer Registry

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6547-6547
Author(s):  
H. Mukai ◽  
T. Higashi ◽  
T. Iwase ◽  
T. Sobue
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cancer Registry ◽  
Cancer Care ◽  
Breast Cancer Patients ◽  
Breast Cancer Care ◽  
Recommended Care ◽  
Adherence Score ◽  
Breast Cancer Registry

6547 Background: In Japan, growing concern that patients do not receive optimum care led to the enactment of the Cancer Control Act in 2006, which mandates the government to undertake initiatives in ensuring the quality of cancer care. Here, we evaluated the current status of breast cancer care in Japan using process-of-care quality indicators (QIs) for breast cancer care. Methods: Combining clinical evidence and expert opinion, we developed 45 QIs covering the continuum of breast cancer care from initial evaluation to follow-up. Each QI describes standards of a particular aspect of care, and its score is calculated as the percentage of applicable patients who received the recommended care (adherence score). Of the 45 QIs, 7 could be scored using data in the Japanese Breast Cancer Registry, which covers about 40% of all Japanese breast cancer patients and has been continuously maintained since 1975. Results: The study population included 15,227 patients registered by 224 facilities in 2005. On average, patients received 72.1% of recommended care. However, substantial variation in adherence was seen across QIs (21–98%). Adherence score was less than 85% in five of seven QIs. Variation across facilities was observed in six QIs. Conclusions: The quality of breast cancer care in Japan has room for improvement in many aspects of care. Although the amount of data in the cancer registry suitable for quality assessment is limited, it is useful in detecting quality problems. [Table: see text] No significant financial relationships to disclose.

Use of imaging for staging of early breast cancer in two integrated health care systems.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 184-184
Author(s):  
Erin Elizabeth Hahn ◽  
Tania Tang ◽  
Janet S. Lee ◽  
Corrine Munoz-Plaza ◽  
Joyce O Adesina ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Cancer Patients ◽  
Early Stage ◽  
Health Care Systems ◽  
Integrated Health Care ◽  
Low Risk ◽  
Breast Cancer Patients ◽  
Chart Abstraction ◽  
Care Systems

184 Background: The initial ASCO “Top 5” list, created as part of the Choosing Wisely campaign, recommends against use of imaging for staging of early stage breast cancer in asymptomatic women at low risk for metastasis. The objective of this study was to measure and compare use of imaging for staging in two large integrated health care systems, Kaiser Permanente (KP) and Intermountain Healthcare (IH). We also sought to distinguish whether imaging was used for routine staging or for diagnostic purposes. Methods: We identified stage 0-IIB breast cancer patients diagnosed between January 1, 2010 and December 31, 2012 with first primary malignancy from tumor registries in three KP regions (Southern California, Northwest, and Mid-Atlantic) and IH. Using the KP and IH electronic health records, we identified use of imaging tests (PET, CT, bone scan) during the staging window (30 days prior to diagnosis up to initial surgery). We performed chart abstraction on a random sample of patients who received an imaging test to identify indication. Results: For the total sample of 10,014, mean age at diagnosis was 60 (range 22-99); with 21% stage 0, 47% stage I, 32% stage II. Overall, 8% of patients (792 patients) received at least one imaging test during the staging window, including 8% at KP and 6% at IH (p=0.0005). Chart abstraction (N=129) revealed that overall, almost half of all imaging tests (48%) were performed to evaluate a symptom, sign or prior imaging finding, including 55% at KP and 32% at IH. Conclusions: Use of imaging for staging of low-risk breast cancer was very low in both health care systems, with clinically trivial differences between them. Approximately half of imaging services were in response to a sign or symptom. Strategies to reduce use of imaging at staging for early stage breast cancer patients within these health care systems are unlikely to yield meaningful improvement. [Table: see text]

scholarly journals The patient-breast cancer care pathway: how could it be optimized?

BMC Cancer ◽  
2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Sandrine Baffert ◽  
Huong Ly Hoang ◽  
Anne Brédart ◽  
Bernard Asselain ◽  
Séverine Alran ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Care Pathway ◽  
Breast Cancer Care

scholarly journals Integration of breast cancer care in a middle-income country: learning from Suandok Breast Cancer Network (SBCN)

BMC Cancer ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Imjai Chitapanarux ◽  
Wimrak Onchan ◽  
Panchaporn Wongmaneerung ◽  
Areewan Somwangprasert ◽  
Nongnuch Bunyoo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Cancer Care ◽  
Breast Cancer Patients ◽  
Breast Cancer Care ◽  
Chiang Mai ◽  
Northern Thailand ◽  
Middle Income ◽  
Cancer Network

Abstract Background Breast cancer incidence in Northern Thailand has shown a continuous increase since records began in 1983. In 2002 the urgency of the situation prompted Maharaj Nakorn Chiang Mai Hospital to initiate the Suandok Breast Cancer Network (SBCN). Methods The SBCN is a not-for-profit organization in the university hospital which serves as a training and education center and provides highly specialized medical care for patients in Chiang Mai and in 5 provinces of northern Thailand, with the key mission of improving breast cancer care. The short-term goal was to overcome the barriers to engagement with breast cancer and its treatment and the long-term goal was to increase the overall survival rate of breast cancer patients in our region. Results We enrolled breast cancer patients treated at Maharaj Nakorn Chiang Mai Hospital between January 2006 and December 2015 and divided into 2 cohorts: 1485 patients who were diagnosed from 2006 to 2009 (cohort 1: early implementation of SBCN) and 2383 patients who were diagnosed from 2010 to 2015 (cohort 2: full implementation of SBCN). Criteria to measure improved cancer waiting time (CWT) would include: time to diagnosis, time to surgery, and time to radiotherapy. The 5-year overall survival (OS) of the cohort 2 was higher than that in cohort 1, at 73.8 (72.0–75.5) compared to 71.5 (69.2–73.7) (p-value = 0.03). Conclusions Reasons behind the success of project include the uniformity of care encouragement, service network development and timely access to each step of breast cancer management. The model used in SBCN could be adopted as a learning guide to improve healthcare access and outcome for breast cancer patients in low- to middle-income countries.

Breast cancer patients' perceived quality of care: The importance of trust and communication

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6554-6554
Author(s):  
R. Franco ◽  
K. P. Joseph ◽  
K. Fei ◽  
N. Bickell
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Quality Care ◽  
Perceived Quality ◽  
Care Quality ◽  
Physician Communication ◽  
Breast Cancer Patients ◽  
Perceived Quality Of Care ◽  
Excellent Care

6554 Background: As insurers consider paying for performance and quality measures grow in importance, factors that affect patients’ perceived quality of cancer care matter. We undertook this study to assess predictors of women's ratings of the quality of their breast cancer care. Methods: 210 of 300 eligible women with stage I or II breast cancer at 1 of 8 participating NYC hospitals were enrolled in our survey: 43 (20%) were African-American (AA), 85 (40%) were white, and 63 (30%) were Hispanic and 19 (9%) were other races. All patients were telephone-surveyed to assess care experiences, knowledge, attitudes & beliefs about breast cancer and its treatment. Trust is based on a validated instrument and calibrated to a 100 point scale (Cronbach α = 0.73). A scale of 5 items assessing physician communication was created and calibrated to100 points (Cronbach α = 0.83). Results: Only 55% of women rated their quality of cancer care as excellent. Compared to women who did not rate their care as excellent, those who did had greater trust in their physician (p < 0.0001), better communication with their physician (p < 0.0001), indicated that were treated well by their physicians’ office staff (p = 0.01), and knew which physician to ask when they had questions (p = 0.0001); age, education & income were not significantly related to patient report of excellent care. AA women were least likely to rate their care as excellent (p = 0.004). AA women had lower levels of trust in their physician (p = 0.02). Patients reporting greater levels of communication also had greater trust (r = 0.38; p < 0.0001). Multivariate models evaluating the role of patient race, education, income, knowing which physician to talk to and how well the staff treated the patient found that being AA (aRR = 0.47; 95% CI: 0.21–0.88), having greater trust (aRR = 1.72; 95% CI:1.49–1.85) and better communication (aRR = 1.38; 95% CI: 1.03–1.65) were significantly associated with patient perception of excellent quality care (p < 0.0001). Conclusions: Greater levels of physician communication about treatment and patient trust of their physician affect women's ratings of excellent cancer care quality. Efforts should be made to improve physician communication about treatment, particularly among AA women, to improve levels of trust and ratings of cancer care quality. No significant financial relationships to disclose.

scholarly journals Did the COVID-19 Pandemic Truly Adversely Affected the Disease Progress and Therapeutic Options in Breast Cancer Patients? - a Single-centre Analysis

2021 ◽  
Author(s):  
Tomasz Nowikiewicz ◽  
Maria Szymankiewicz ◽  
Marta Drzewiecka ◽  
Iwona Glowacka-Mrotek ◽  
Magdalena Tarkowska ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Health Care Systems ◽  
Economic Life ◽  
Breast Cancer Patients ◽  
Hospitalised Patients ◽  
Care Systems ◽  
Clinical Consequences ◽  
Treated Breast

Abstract Purpose The mass and uncontrolled spreading of infections with the SARS-CoV-2 virus resulted in significant disruptions affecting most areas of the social and economic life all over the world. The most important changes concerned problems related to functioning of health care systems. The aim of this study was to evaluate clinical consequences associated with the COVID-19 pandemic for patients with newly diagnosed breast cancer, treated at our centre.Methods The study participants were patients first time diagnosed with breast cancer, treated between January 2019 and March 2021, who were provided any type of cancer treatment at our centre. The study determined the grade of clinical and pathological progress of the disease and types of cancer treatment applied in patients.Results 2863 patients in total were included in the analysis. The number of hospitalised patients was 1228 (1123 treated surgically, 105 receiving conservative treatment) in 2019, 1318 (1206 and 112 patients, respectively) in 2020, and 317 (288 and 29 patients, respectively) in 2021. Conclusions Despite many hazards associated with the new epidemiological situation, we were able to maintain the continuous operation of our centre. We have achieved a measurable success, and even managed to increase the number of treated breast cancer patients.

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