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  • Measure Summary
  • NQMC:011221
  • Jul 2016

Breast cancer: proportion of patients with invasive breast cancer who have a greater than or equal to 5% overall survival benefit of chemotherapy treatment predicted at 10 years that undergo adjuvant chemotherapy.

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Breast cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jul. 37 p. [21 references]

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the proportion of patients with invasive breast cancer who have a greater than or equal to 5% overall survival benefit of chemotherapy treatment predicted at 10 years that undergo adjuvant chemotherapy.

Note from the National Quality Measures Clearinghouse: This measure is part of the Cancer Quality Performance Indicators (QPIs) collection. For more information, including a complete list of QPI measure sets, please visit the Healthcare Improvement Scotland Web site External Web Site Policy.

Rationale

Large randomised trials have confirmed that adjuvant systemic therapy improves relapse-free survival and overall survival (NHS Quality Improvement Scotland, 2008).

Clinical trials have demonstrated that adjuvant drug treatments substantially reduce 5-year recurrence rates and 15-year mortality rates (Early Breast Cancer Trialists' Collaborative Group [EBCTCG], 2005).

Success of treatment is based on a number of different factors including tumour size, grade and involvement of lymph nodes. Prognostic tools such as PREDICT assist clinicians and patients to make informed decisions on appropriate treatment by predicting survival and determining those patients likely to benefit from adjuvant treatment (Wishart et al., 2010; Wishart et al., 2012).

Evidence for Rationale

Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005 May 14-20;365(9472):1687-717. PubMed External Web Site Policy

NHS Quality Improvement Scotland. Management of breast cancer services. Edinburgh (Scotland): NHS Quality Improvement Scotland; 2008 Jul. 58 p. [50 references]

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Breast cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jul. 37 p. [21 references]

Wishart GC, Azzato EM, Greenberg DC, Rashbass J, Kearins O, Lawrence G, Caldas C, Pharoah PD. PREDICT: a new UK prognostic model that predicts survival following surgery for invasive breast cancer. Breast Cancer Res. 2010;12(1):R1. PubMed External Web Site Policy

Wishart GC, Bajdik CD, Dicks E, Provenzano E, Schmidt MK, Sherman M, Greenberg DC, Green AR, Gelmon KA, Kosma VM, Olson JE, Beckmann MW, Winqvist R, Cross SS, Severi G, Huntsman D, Pylkäs K, Ellis I, Nielsen TO, Giles G, Blomqvist C, Fasching PA, Couch FJ, Rakha E, Foulkes WD, Blows FM, Bégin LR, van't Veer LJ, Southey M, Nevanlinna H, Mannermaa A, Cox A, Cheang M, Baglietto L, Caldas C, Garcia-Closas M, Pharoah PD. PREDICT Plus: development and validation of a prognostic model for early breast cancer that includes HER2. Br J Cancer. 2012 Aug 21;107(5):800-7. PubMed External Web Site Policy

Primary Health Components

Invasive breast cancer; overall survival; adjuvant chemotherapy

Denominator Description

All patients with invasive breast cancer who have a greater than or equal to 5% overall survival benefit of chemotherapy treatment predicted at 10 years (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of patients with invasive breast cancer who have a greater than or equal to 5% overall survival benefit of chemotherapy treatment predicted at 10 years that undergo adjuvant chemotherapy (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

The collection of data is piloted on a small number of patient records using a paper data collection form produced by Information Services Division (ISD). The aim is to identify any anomalies or difficulties with data collection prior to full implementation. At least one NHS board in each Regional Cancer Network participates in the pilot.

Evidence for Extent of Measure Testing

NHS Scotland. National cancer quality performance indicators: overview of development process. Edinburgh (Scotland): NHS Scotland; 2012 Dec. 7 p.

State of Use

Current routine use

Current Use

Internal quality improvement

National reporting

Public reporting

Measurement Setting

Ambulatory/Office-based Care

Ambulatory Procedure/Imaging Center

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Unspecified

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Diagnostic Evaluation

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients with invasive breast cancer who have a greater than or equal to 5% overall survival benefit of chemotherapy treatment predicted at 10 years

Note: The validated tool PREDICT should be used to calculate predicted benefit of adjuvant chemotherapy.

Exclusions

  • All patients with breast cancer taking part in trials of chemotherapy treatment
  • All patients with breast cancer who have had neo-adjuvant chemotherapy
  • All patients with M1 disease

Exclusions/Exceptions

Medical factors addressed

System factors addressed

Numerator Inclusions/Exclusions

Inclusions
Number of patients with invasive breast cancer who have a greater than or equal to 5% overall survival benefit of chemotherapy treatment predicted at 10 years that undergo adjuvant chemotherapy

Exclusions

  • All patients with breast cancer taking part in trials of chemotherapy treatment
  • All patients with breast cancer who have had neo-adjuvant chemotherapy
  • All patients with M1 disease

Numerator Search Strategy

Fixed time period or point in time

Data Source

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Prescriptive standard

Prescriptive Standard

Target: 85%

The tolerance within this target accounts for factors of patient choice, co-morbidities and fitness for treatment.

Note: Varying evidence exists regarding the most appropriate target level; therefore this may need redefined in the future, to take account of new evidence or when baseline data becomes available.

Evidence for Prescriptive Standard

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Breast cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jul. 37 p. [21 references]

Original Title

QPI 11 – adjuvant chemotherapy.

Measure Collection Name

Cancer Quality Performance Indicators (QPIs)

Measure Set Name

Breast Cancer

Submitter

NHS Scotland - National Government Agency [Non-U.S.]

Scottish Cancer Taskforce - National Government Agency [Non-U.S.]

Developer

NHS Scotland - National Government Agency [Non-U.S.]

Scottish Cancer Taskforce - National Government Agency [Non-U.S.]

Funding Source(s)

Scottish Government

Composition of the Group that Developed the Measure

Breast Cancer QPI Development Group

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2016 Jul

Measure Maintenance

The Cancer Quality Performance Indicators (QPIs) will be kept under regular review and be responsive to changes in clinical practice and emerging evidence.

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

Source(s)

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Breast cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jul. 37 p. [21 references]

Measure Availability

Source document available from the Healthcare Improvement Scotland Web site External Web Site Policy.

For more information, contact the Healthcare Improvement Scotland at Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland EH12 9EB; Phone: 0131 623 4300; E-mail: comments.his@nhs.net; Web site: www.healthcareimprovementscotland.org/ External Web Site Policy.

Companion Documents

The following is available:

  • NHS Scotland. National cancer quality performance indicators: overview of development process. Edinburgh (Scotland): NHS Scotland; 2012 Dec. 7 p. This document is available from the Healthcare Improvement Scotland Web site External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on June 7, 2017.

Copyright Statement

No copyright restrictions apply.

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