scholarly journals Breast Cancer Care Quality in South Africa’s Public Health System: An Evaluation Using American Society of Clinical Oncology/National Quality Forum Measures

2019 ◽  
pp. 1-16
Author(s):  
Daniel S. O’Neil ◽  
Wenlong Carl Chen ◽  
Oluwatosin Ayeni ◽  
Sarah Nietz ◽  
Ines Buccimazza ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Endocrine Therapy ◽  
South African ◽  
Hormone Receptor ◽  
Cancer Care ◽  
Care Quality ◽  
Public Hospitals ◽  
Sub Saharan Africa ◽  
Breast Cancer Care

PURPOSE The quality of breast cancer care in sub-Saharan Africa contributes to the region’s dismal breast cancer mortality. ASCO has issued quality measures focusing on delivery of adjuvant chemotherapy, radiotherapy, and endocrine therapy. We applied these measures in five South African public hospitals and analyzed factors associated with care concordance. MATERIALS AND METHODS Among 1,736 women with breast cancer who were enrolled in the South African Breast Cancer and HIV Outcomes study over 24 months, we evaluated care using ASCO’s three measures. We also evaluated adjuvant chemotherapy receipt in 957 women with an indication. We used logistic regression to estimate associations between measure-concordant care and patient factors. RESULTS Of 235 women with hormone receptor–negative cancer, 173 (74%) began adjuvant chemotherapy within 120 days from diagnosis. Of 194 patients who received breast-conserving surgery, 73 (37%) began radiotherapy within 365 days from diagnosis. Of 999 women with hormone receptor–positive cancer, 719 (72%) initiated endocrine therapy within 365 days from diagnosis. Chemotherapy and radiotherapy measure-concordant care were more common among women residing < 20 km from the hospital (odds ratio [OR], 1.79; 95% CI, 1.32 to 2.44 and OR, 3.17; 95% CI, 1.57 to 6.42). Endocrine therapy measure-concordant care was more common among English-speaking women (OR, 2.12; 95% CI, 1.12 to 4.02). Participating hospitals varied in care concordance. HIV infection did not affect care quality. CONCLUSION More timely delivery of chemotherapy, radiotherapy, and endocrine therapy is needed in South Africa, particularly for women living > 20 km from the hospital or not speaking English. Focused quality improvement efforts could support that goal.

scholarly journals Identifying Breast Cancer Care Quality Measures for a Cancer Facility in Rural Sub-Saharan Africa: Results of a Systematic Literature Review and Modified Delphi Process

2020 ◽  
pp. 1446-1454
Author(s):  
Lydia E. Pace ◽  
Lauren E. Schleimer ◽  
Cyprien Shyirambere ◽  
André Ilbawi ◽  
Jean Marie Vianney Dusengimana ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Quality Measurement ◽  
Quality Measures ◽  
Care Quality ◽  
Delphi Process ◽  
Sub Saharan Africa ◽  
Breast Cancer Care ◽  
Modified Delphi ◽  
Sub Saharan

PURPOSE The burden of cancer is growing in low- and middle-income countries (LMICs), including sub-Saharan Africa. Ensuring the delivery of high-quality cancer care in such regions is a pressing concern. There is a need for strategies to identify meaningful and relevant quality measures that are applicable to and usable for quality measurement and improvement in resource-constrained settings. METHODS To identify quality measures for breast cancer care at Butaro Cancer Center of Excellence (BCCOE) in Rwanda, we used a modified Delphi process engaging two panels of experts, one with expertise in breast cancer evidence and measures used in high-income countries and one with expertise in cancer care delivery in Rwanda. RESULTS Our systematic review of the literature yielded no publications describing breast cancer quality measures developed in a low-income country, but it did provide 40 quality measures, which we adapted for relevance to our setting. After two surveys, one conference call, and one in-person meeting, 17 measures were identified as relevant to pathology, staging and treatment planning, surgery, chemotherapy, endocrine therapy, palliative care, and retention in care. Successes of the process included participation by a diverse set of global experts and engagement of the BCCOE community in quality measurement and improvement. Anticipated challenges include the need to continually refine these measures as resources, protocols, and measurement capacity rapidly evolve in Rwanda. CONCLUSION A modified Delphi process engaging both global and local expertise was a promising strategy to identify quality measures for breast cancer in Rwanda. The process and resulting measures may also be relevant for other LMIC cancer facilities. Next steps include validation of these measures in a retrospective cohort of patients with breast cancer.

scholarly journals Top 3 abstracts concerning hormone-receptor-positive early breast cancer

2021 ◽  
Author(s):  
Simon Peter Gampenrieder ◽  
Gabriel Rinnerthaler ◽  
Richard Greil
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Endocrine Therapy ◽  
Early Breast Cancer ◽  
Hormone Receptor ◽  
Menopausal Status ◽  
Pathologic Complete Response ◽  
Oncotype Dx ◽  
Hormone Receptor Positive ◽  
Her2 Breast Cancer

SummaryThe three top abstracts at the 2020 virtual San Antonio Breast Cancer Symposium regarding hormone-receptor-positive early breast cancer, from our point of view, were the long-awaited results from PenelopeB and RxPONDER as well as the data from the ADAPT trial of the West German Study Group. PenelopeB failed to show any benefit by adjuvant palbociclib when added to standard endocrine therapy in patients without pathologic complete response after neoadjuvant chemotherapy. RxPONDER demonstrated that postmenopausal patients with early hormone receptor positive (HR+)/human epidermal growth factor receptor 2 negative (HER2−) breast cancer, 1–3 positive lymph nodes and an Oncotype DX Recurrence Score of less than 26 can safely be treated with endocrine therapy alone. In contrast, in premenopausal women with positive nodes, adjuvant chemotherapy plays still a role even in case of low genomic risk. Whether the benefit by chemotherapy is mainly an indirect endocrine effect and if ovarian function suppression would be similarly effective, is still a matter of debate. The HR+/HER2− part of the ADAPT umbrella trial investigated the role of a Ki-67 response to a short endocrine therapy before surgery in addition to Oncotype DX—performed on the pretreatment biopsy—to identify low-risk patients who can safely forgo adjuvant chemotherapy irrespective of menopausal status.

scholarly journals Breast Cancer Care in South India: Is Practice Concordant With National Guidelines?

2019 ◽  
pp. 1-7 ◽  
Author(s):  
D.K. Vijaykumar ◽  
Sujana Arun ◽  
Aswin G. Abraham ◽  
Wilma Hopman ◽  
Andrew G. Robinson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Lymph Nodes ◽  
Cancer Care ◽  
Adjuvant Radiotherapy ◽  
South India ◽  
Breast Cancer Care ◽  
Adjuvant Trastuzumab ◽  
Positive Lymph Nodes

PURPOSE The National Cancer Grid (NCG) of India has recently published clinical practice guidelines that are relevant in the Indian context. We evaluated the extent to which breast cancer care at a teaching hospital in South India was concordant with NCG guidelines. METHODS All patients who had surgery for breast cancer at a single center from January 2014 to December 2015 were included. Demographic, pathologic, and treatment characteristics were extracted from the electronic medical record. Patients were classified as being concordant with six elements selected from the NCG guideline. The indicators related to appropriate use of sentinel lymph node (SLN) biopsy, lymph node harvest, adjuvant radiotherapy, adjuvant chemotherapy, human epidermal growth factor receptor 2 (HER2) testing, and delivery of adjuvant trastuzumab. RESULTS A total of 401 women underwent surgery for breast cancer; mean age (standard deviation) was 57 (12) years. Lymph node involvement was present in 47% (188 of 401) of the cohort; 23% (94 of 401) had T1 disease. Ninety-two percent (368 of 401) underwent radical modified mastectomy. SLN biopsy was performed in 75% (167 of 222) of eligible patients. Eighty percent (208 of 261) of patients with a positive SLN biopsy or no SLN biopsy had a lymph node harvest of more than 10. Adjuvant chemotherapy with an anthracycline and a taxane was delivered to 67% of patients (118 of 177) with node-positive disease. Adjuvant radiotherapy was delivered to 84% (180 of 213) of patients with breast-conserving surgery, T4 tumors, or 3+ positive lymph nodes. Fluorescent in situ hybridization testing was performed in 59% of patients (43 of 73) with 2+ HER2-positive lymph nodes on immunohistochemistry. Among patients with HER2 overexpression, 40% (36 of 91) received adjuvant trastuzumab. CONCLUSION Concordance with NCG guidelines for breast cancer care ranged from 40% to 84%. Guideline concordance was lowest for those elements of care associated with the highest direct costs to patients.

scholarly journals Modest benefits of adjuvant chemotherapy in hormone receptor-positive breast cancer

2006 ◽  
Vol 9 (7) ◽  
pp. 1-4 ◽  
Author(s):  
Tiffany H. Svahn ◽  
Robert W. Carlson
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Endocrine Therapy ◽  
Hormone Receptor ◽  
Progesterone Receptors ◽  
Metastatic Breast ◽  
Adjuvant Trastuzumab ◽  
Hormone Receptor Positive ◽  
Trastuzumab Therapy ◽  
Positive Breast Cancer

The benefits of adjuvant chemotherapy, endocrine therapy, and trastuzumab therapy are well-established in patients with early breast cancer. Further, there are patient and tumor characteristics that can assist in predicting which patients are more likely to benefit from specific adjuvant therapies. For example, patients whose tumors express estrogen and/or progesterone receptors (ER/PR) derive significant benefit from adjuvant endocrine therapy, whereas those whose tumors do not express these receptors derive very little or no benefit from endocrine therapy [1]. Patients whose tumors overexpress HER2 experience profound benefits from treatment with adjuvant trastuzumab [2,3]. We have recently begun to understand that ER/PR-positive breast cancer also responds differently to chemotherapy than its hormone receptor-negative counterpart. This is not, however, entirely new information. As early as 1978, it was retrospectively observed that ER-positive metastatic breast cancer had lower response rates to a variety of older chemotherapy regimens than did ER-negative disease [4].

scholarly journals Evaluation of the Quality of Adjuvant Endocrine Therapy Delivery for Breast Cancer Care in the United States

JAMA Oncology ◽  
2017 ◽  
Vol 3 (7) ◽  
pp. 928 ◽  
Author(s):  
Bobby Daly ◽  
Olufunmilayo I. Olopade ◽  
Ningqi Hou ◽  
Katharine Yao ◽  
David J. Winchester ◽  
...  
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Endocrine Therapy ◽  
Cancer Care ◽  
The United States ◽  
Adjuvant Endocrine Therapy ◽  
Breast Cancer Care ◽  
Therapy Delivery

scholarly journals Hormone receptor-positive early breast cancer: controversies in the use of adjuvant chemotherapy

2009 ◽  
Vol 16 (4) ◽  
pp. 1091-1102 ◽  
Author(s):  
Filippo Montemurro ◽  
Massimo Aglietta
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Endocrine Therapy ◽  
Hormone Receptor ◽  
Combined Treatment ◽  
Her2 Positive ◽  
Hormone Receptor Positive ◽  
Current Controversy ◽  
Molecular Bases

Current adjuvant treatments for operable breast cancer include chemotherapy, endocrine therapy in hormone receptor-positive tumors, and trastuzumab for HER2-positive tumors. Metanalyses of randomized trials show that in patients with hormone receptor-positive breast cancer, the effects of endocrine therapy and chemotherapy on survival are non-mutually exclusive. Most of these patients are therefore considered candidates to combined treatment. Recently, however, the endocrine responsiveness of tumors has been redefined on clinical, histopathological, and molecular bases. An emerging concept is that as endocrine responsiveness increases, chemoresponsiveness decreases. In the adjuvant setting, therapeutic choices are often based on small projected improvements in clinical outcomes. As a consequence, the role of chemotherapy and traditional management algorithms in patients with hormone receptor positive is being challenged. This review will address the current controversy regarding the role of adjuvant chemotherapy, including the newer anthracycline and taxane-based programs, in these patients.

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