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Report Title: Healthcare Performance Measurement & Reporting for Breast Cancer
services in Malaysia, for 2011
Protocol
number:
HR 2011-02
Document
type:
Healthcare Performance Report
Document
status:
Draft
Report
period
2011 data
Database As of 30 January 2013
Release
Date:
Version 2.8 30 January 2013
Number of
pages:
21
Investigators,
Site
Coordinator
and Hospital
management
# Investigators: Institution:
1. Dato Dr Ibrahim A. Wahid Beacon International Specialist Centre
2. Dr Azura Rozila Ahmad Beacon International Specialist Centre
3. Dr Chong Kwang Jeat Mahkota Medical Centre
4. Dr Jayendran s/o Dharmaratnam Mahkota Medical Centre
5. Dr Ho Kean Fatt Mount Miriam Cancer Hospital
6. Dr Amir Shah Mount Miriam Cancer Hospital
7. Dr Kananathan s/o Ratnavelu NCI Hospital
8. Dr Gerard Lim Chin Chye Hospital Kuala Lumpur
9. Dr. Nor Aina Emran Hospital Kuala Lumpur
10. Dr Amin Hospital Kuala Lumpur
11. Dr Azizah Ahmad Hospital Kuala Lumpur
12. Dr Chan Wee Han Hospital Kuala Lumpur
13. Dr Hayani Hospital Kuala Lumpur
14. Dr Lau Fen Nee Hospital Kuala Lumpur
15. Dr Lau Kah Liew Hospital Kuala Lumpur
16. Dr Lim Boon Leong Hospital Kuala Lumpur
17. Dr Mohd Faisal Hospital Kuala Lumpur
18. Dr Nik Abdullah Hospital Kuala Lumpur
19. Dr Rachael Khong Kit-tsan Hospital Kuala Lumpur
20. Dr Ros Suzanna Hospital Kuala Lumpur
21. Dr Zabedah Hospital Kuala Lumpur
22. Dr Abel Arumugam Sime Darby Medical Centre
23. Dr Cha Kar Huei Sime Darby Medical Centre
24. Dr Foo Kin Keong Sime Darby Medical Centre
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25. Dr Lyou Yen Tian Sime Darby Medical Centre
26. Dr Ong Kee Thiam Sime Darby Medical Centre
27. Dr Samuel Tay Kwan Sim Sime Darby Medical Centre
28. Dr. Matin Mellor Abdullah Sime Darby Medical Centre
29. Dr. Ahmad Kamal Mohamed Sime Darby Medical Centre
30. Dr. Foo Yoke Ching Sime Darby Medical Centre
31. Dr. Leong Kin Wah Gleneagles Medical Centre Pinang
32. Dato’ Dr Mohamed Adel Mohd Zaatar Gleneagles Medical Centre Pinang &
Mount Mariam Cancer Hospital
33. Prof Dr Yip Cheng Har University Malaya Medical Centre
34. Prof. Dr. Nur Aishah University Malaya Medical Centre
35. Dr. Ho Gwo Fuang University Malaya Medical Centre
36. Dr Teh Yew Ching University Malaya Medical Centre
37. Dr See Mee Hong University Malaya Medical Centre
Site
Coordinator
# Site Coordinators: Institution:
1. Ms Umadewi A/P Ravindranathan Beacon International Specialist Centre
2. Ms Harisah Binti Ab Rahman Mahkota Medical Centre Melaka
3. Ms Rashidah Abd Rashid Mahkota Medical Centre Melaka
4. Ms Lim Sheau Yong Mahkota Medical Centre Melaka 5. Ms Zaharah Binti Mohd Mahkota Medical Centre Melaka 6. SR Kanageswari Ramasamy Mount Miriam Cancer Hospital 7. Dr Lim Chiao Mei NCI Hospital 8. Ms Tamil Selvi Aruguman NCI Hospital 9. Ms Satwant Kaur NCI Hospital 10. Ms Catherine Lee May Ling Sime Darby Medical Centre 11. Ms. Annie Kahar Sime Darby Medical Centre 12. Ms. Siah Ning Sing Sime Darby Medical Centre 13. Ms Parameswary A/P Ellamaran Sime Darby Medical Centre 14. Ms Mandy Yap Seen Mun Sime Darby Medical Centre 15. Ms Ester Ho Siow Yean Sime Darby Medical Centre 16. Ms Mabel Keay Pei Pei Gleneagles Medical Centre Pinang
Consultant Lim T.O. FRCP, M.Stat
Statisticians Hoo LP PhD, Lena Yeap MSc, Stats Consulting
Data
manager
Teo JS MSc,ClinData Consulting
Project
manager and
staff
Ms Iris Tan Guak Wah, MySMO
Ms Intan Munirah Mohd Murad, MySMO
Ms Chin Mei Lin, MySMO
Mr Leslie Bong, MySMO
Ms Jacelyn Tan Ying Ling, MySMO
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Contents Introduction and Rationale ........................................................................................................................... 4 Data ............................................................................................................................................................... 5 Results & Discussion ..................................................................................................................................... 5 Conclusion ..................................................................................................................................................... 5 References .................................................................................................................................................... 6 Tables and Graphs ......................................................................................................................................... 7
Table 1.0: Data reporting for Breast cancer .............................................................................................. 7
Table 1.1: Missing Data precluding Breast Cancer Care performance analysis for Patients diagnosed in
year 2011 .................................................................................................................................................. 8
Table 2.0: Patients’ Characteristics at diagnosis, All Patients diagnosed in 2011 (H1 and H2 Cohorts) .. 9
Table 3.0: Tumor Characteristics at diagnosis, Patients diagnosed in year 2011 ................................... 10
Table 4.0: Treatment of Breast Cancer Patients diagnosed in year 2011 ............................................... 11
Table 5.0: Summary of Breast Cancer care performance for Patients diagnosed in year 2011 ............ 14
Table 5.1: Pathology Report confirming diagnosis for Breast Cancer (BC) patients in year 2011 ...... 14
Table 5.2: Staging within one month of first visit for Breast Cancer (BC) patients in year 2011 ........ 15
Table 5.3: Documented plan for chemotherapy for Breast Cancer (BC) patients in year 2011 .......... 15
Table 5.4: Steroids/Serotonin antagonist prescribed for moderate/high emetic risk chemotherapy
for Breast Cancer (BC) patients in year 2011 ...................................................................................... 15
Table 5.5: Radiation therapy for Stage I to III breast cancer after breast conserving surgery within 1
year of diagnosis for Breast Cancer (BC) patients in year 2011 .......................................................... 16
Table 5.6: Combination chemotherapy for Stage I to III ER/PR negative cancer within 4 months of
diagnosis for Breast Cancer (BC) patients in year 2011 ...................................................................... 17
Table 5.7: Tamoxifen or AI for Stage I to III ER or PR positive cancer within 1 year of diagnosis for
Breast Cancer (BC) patients in year 2011 ............................................................................................ 18
Table 5.8: Trastuzumab for Stage I to III HER2 positive cancer within 1 year of diagnosis for Breast
Cancer (BC) patients in year 2011 ....................................................................................................... 19
Appendix: Definition of Performance Measures for Breast Cancer care ................................................... 20
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Introduction and Rationale Measuring the performance of health services and using these measurements for accountability
purposes or to promote improvements in the delivery of care, are increasingly evident in
developed countries. Malaysia has lagged behind in this area until in recent years when our
government introduced KPI to measure the performance of government services as part of the
Government Transformation Programme. This has provided the impetus for measuring the
performance of our health services. HPMRS (more at www.hpmrs.com.my ) the local healthcare
performance measurement system was developed to meet the increasing demands from clients’
for such services. Several projects are underway targeting cancer, cardiac and eye health services
in Malaysia. Cancer care services, and specifically breast cancer services, is the focus of this
report.
For the purpose of measuring breast cancer care performance, we mostly adopted the
performance measures developed by Quality Oncology Practice Initiative (QOPI) [1,2] and
American Society of Clinical Oncology/National Comprehensive Cancer Network (ASCO-
NCCN) [3,4], while taking into account local clinical practice guideline [5]. These performance
measures are listed in the Table below; refer Appendix for their definitions.
# Performance measure Source
1. Pathology report confirming malignancy QOPI [1,2]
2. Staging documented within one month of first visit to reporting
centre
QOPI [1,2]
3. Documented plan for chemotherapy, including doses, route, and
time intervals
QOPI [1,2]
4. Corticosteroids and serotonin antagonist prescribed with
moderate/high emetic risk chemotherapy
QOPI [1,2]
5. Radiation therapy for women under age 70 with Stage I toIII
breast cancer who had breast conserving surgery for breast
cancer within 1 year (365 days) of date of diagnosis
ASCO-NCCN [3,4]
6. Adjuvant multi-agent (combination) chemotherapy for women
under age 70 with Stage I (Tc) to III ER/PR negative breast
cancer within 120 days of date of diagnosis
ASCO-NCCN [3,4]
7. Tamoxifen or Aromatase Inhibitor for women greater than age
17 with Stage I to III ER or PR positive breast cancer within 1
year (365 days) of date of diagnosis
ASCO-NCCN [3,4]
8. Trastuzumab therapy for women greater than age 17 with Stage I
(Tc) to III HER2 positive breast cancer within 1 year (365 days)
of date of diagnosis
QOPI [1,2]
9. Risk adjusted 5-year relative survival International Cancer
Benchmarking Partnership
[6] & CONCORD [7]
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Data In 2011, data were collected from 1141 patients diagnosed to have breast cancer at 8 hospitals in
Malaysia. For the purpose of performance measurement, the data were usable from 931 eligible
patients. Another 169 patients were potentially eligible but had incomplete data and were thus
excluded from analysis (Missing or invalid data: 12 patient for date of diagnosis, 35 for tumor
staging; 136 for ER/PR or HER2 status).
Results & Discussion The mean age of these patients with breast cancer diagnosed in 2011 was only 53 years; about
40% was aged <50 years.
For patients first presenting at a treatment centre, it took a median of 6 days to arrive at a
diagnosis of cancer.
59% of patients were diagnosed with Early Breast Cancer (Stage 1 or 2, EBC), another 29% with
Locally Advanced Cancer and only 12% with late stage metastatic cancer.
67% were ER+, 59% PR+, 35% HER2+ and 17% triple negative.
Breast Cancer care performance
Table 5 summarizes the performance results. Overall, Breast Cancer care result is 75%. A 75
percent composite score means that the centres provided an evidence-based Breast cancer
treatment 75 times for every 100 opportunities to do so.
Performance for the 7 individual performance measures (excluding survival outcome and
Steroids/Serotonin antagonist prescribed) varies from as low as 18% (Trastuzumab treatment) to
a high core of 96% (Pathology report confirming malignancy)
Cancer survival outcome
It is too early to report on cancer survival outcomes.
Conclusion It has been shown that without clear target and in-built performance monitoring and data
collection system, health services for any particular patient groups will invariably fail to improve
[8]. The HPMRS is specifically designed to measure the performance of our cancer services
through monitoring access to diagnostic and treatment services and survival outcome of
representative cohorts of patients diagnosed with breast cancer, and on this basis motivate the
improvement in health services for these patients. A high performing health service will ensure
that patients be diagnosed early and have timely access to needed treatment, and thereby ensure
optimal cancer survival and minimal avoidable deaths.
To our knowledge, this is the first time cancer care in Malaysia has ever been subjected to
performance monitoring. Beginning from January 2011, 8 hospitals in Malaysia from the MOH,
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University and Private sectors embark on routine measurement of the performance of their
cancer care services. Breast cancer patients took as long as a year to complete their treatments,
we could therefore only report now (at the beginning of 2013) on the performance of the care
received by the year 2011 patient cohort.
The results clearly show there is room for improvement, and certainly we have some way to go
before we could meet world class benchmark. Such results are to be expected, for wherever and
whenever the performances of health services are first subject to measurement, they invariably
come up short. The results from this first effort should serve as the baseline against which future
improvement will be compared.
References 1. Campion FX, Larson LR, Kadlubek PJ, Earle CC, et al. Advancing Performance
Measurement in Oncology: Quality Oncology Practice Initiative (QOPI) Participation and
Quality Outcomes. J Oncol Pract 2011;7:31S-35S
2. QOPI Quality Measures. Available at:
http://qopi.asco.org/Documents/QOPISpring2012MeasuresSummary_000.pdf
3. Desch CE, McNiff KK, Schneider EC, Schrag D et al. American Society of Clinical
Oncology/National Comprehensive Cancer Network Quality Measures. J Clin Oncol 2008;
26:3631-3637
4. ASCO-NCCN Quality Measures for Breast and Colorectal cancer care. Available at:
http://www.asco.org/ASCOv2/Practice+%26+Guidelines/Quality+Care/Quality+Measureme
nt+%26+Improvement/ASCO-NCCN+Quality+Measures
5. MOH and AMM Malaysia. Clinical Practice Guidelines: Management of Breast Cancer 2nd
edition. 2010
6. Coleman MP, Forman D, Bryant H, Butler J et al, and the ICBP Module 1 Working Group.
Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007
(the International Cancer Benchmarking Partnership): an analysis of population-based
cancer registry data. Lancet 2010; Published Online
7. Coleman MP, Quaresma M, Berrino F, Lutz JM, et al. Cancer survival in five continents: a
worldwide population-based study (CONCORD). Lancet Oncol 2008; 9: 730–56
8. Editorial. Neurological diseases remain neglected and ignored Lancet 2012;379:287
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Tables and Graphs
Table 1.0: Data reporting for Breast cancer
2011 2012
Centre Jan-June
(H1
cohort)
July-Dec.
(H2
cohort)
Total* Jan-June
(H1
cohort)
July-Dec.
(H2
cohort)
Total*
1. Hospital Kuala
Lumpur 203(60) 133(39) 340(100) 79(99) 0(0) 80(100)
2. Sime Darby Medical
Centre 63(52) 57(47) 121(100) No data No data No data
3. University Malaya
Medical Centre 173(59) 115(39) 292(100) 5(100) 0(0) 5(100)
4. Beacon International
Specialist Centre 12(52) 11(48) 23(100) 11(52) 10(48) 21(100)
5. Gleneagles Medical
Centre Penang 26(52) 24(48) 50(100) 9(82) 2(18) 11(100)
6. Mahkota Medical
Centre Melaka 74(54) 62(46) 136(100) 38(100) 0(0) 38(100)
7. Mount Mariam
Cancer Hospital 58(55) 48(45) 106(100) 51(51) 49(49) 100(100)
8. NCI Nilai 22(30) 48(66) 73(100) 41(71) 16(28) 58(100)
Total 631(55) 498(44) 1141(100) 234(75) 77(25) 313(100)
*Total may be more than H1 +H2 cohort because of imprecise dates
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Table 1.1: Missing Data precluding Breast Cancer Care performance analysis for
Patients diagnosed in year 2011
2011 potential Cohort
N=1141
Exclusion from analysis
N=41
Ineligible for analysis
(Non-epithelial tumor, Non-primary tumor)
N=169
Incomplete data
Refer Table for details
N=931
Overall analysis set
# Data quality & Documentation issues No (%) missing
Total number of potential patients in 2011 cohort 1141
Ineligibility Data
1. Non-primary tumor 1
2. Non-epithelial tumor 40
Total number of patients excluded because of ineligibility 41
Variables with Missing Data
1. Date of diagnosis invalid or missing 12
2. Age 0
3. Sex 0
4. Date presentation 0
5. Staging 35
6. Tumor size of stage 1 0
7. HPE report 0
8. ER/PR or HER2 status 136
Total number of patients excluded because of missing data* 169
*1 patient may have more than 1 type of variable missing.
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Table 2.0: Patients’ Characteristics at diagnosis, All Patients diagnosed in 2011
(H1 and H2 Cohorts)
Patient characteristics Statistics Results
Number of patients Number 1129(100%)
Age, years Mean (SD) 53(11)
Median (IQR) 53(45, 61)
(Min, Max) (23, 87)
Age distribution No. (%) Age<40 133(12)
No. (%) Age 40 to 49 312(28)
No. (%) Age 50 to 59 370(33)
No. (%) Age>=60 314(28)
Sex No. (%) Male 3(0)
No. (%) Female 1126(100)
Race No. (%) Malay 363(32)
No. (%) Chinese 512(45)
No. (%) Indian 124(11)
No. (%) Orang Asli 2(0)
No. (%) Bumiputera Sabah 1(0)
No. (%) Foreigner 100(9)
No. (%) Others 26(2)
Origin No. (%) Local 490(43)
No. (%) Referral 639(57)
Duration from first
presentation at site to
diagnosis, in days (for patients
from reporting centre only)
Number of patients first presenting
at Reporting Centre with
298
Mean (SD) 17(33)
Median (IQR) 6(1, 17)
(Min, Max) (0, 309)
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Table 3.0: Tumor Characteristics at diagnosis, Patients diagnosed in year 2011
Tumor
characteristics
Statistics Results
Number of patients Number (%) 931(100)
Stage at diagnosis No. (%) Early Breast Cancer (EBC) 553(59)
No. (%) Locally Advanced Breast Cancer (LABC) 267(29)
No. (%) Metastatic Breast Cancer (MBC) 111(12)
Tumor size No (%) T1 (1 to 20mm) 191(21)
No (%) T2 (21 to 50mm) 279(30)
No (%) T3 (> 50mm) 83(9)
No (%) Unknown 378(41)
Tumor histology No (%) Infiltrating duct carcinoma, NOS 611(66)
No (%) Intraductal carcinoma, noninfiltrating, NOS 23(2)
No (%) Other Carcinomas 297(32)
Grading No (%) Grade 1 54(6)
No (%) Grade 2 342(37)
No (%) Grade 3 315(34)
No (%) No information 220(24)
Biomarkers Number (%) 931(100)
No. (%) ER+ 624(67)
No. (%) PR+ 547(59)
No. (%) HER2 ISH+ or IHC+ if ISH missing or
unknown 257(35)
No. (%) Triple positive (ER+, PR+ HER+) 113(15)
No. (%) Triple negative (ER-, PR- HER-) 126(17)
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Table 4.0: Treatment of Breast Cancer Patients diagnosed in year 2011
Treatment of BC patients Statistics Results
Surgical treatment
Number of patients who had
surgery
Number of patients
834(100)
Duration from diagnosis to
surgery, in day
Number of patients with data on duration
833
Number of patients without data on duration 1
Mean (SD) 28(66)
Median (IQR) 3(0, 23)
(Min, Max) (0, 709)
No. (%) Duration less or equal to 60 days 740(89)
No. (%) Duration less or equal to 120 days 774(93)
No. (%) Duration less or equal to 180 days 802(96)
Type of Surgical treatment No. (%) Breast conserving surgery 200(24)
No. (%) Radical surgery 548(66)
No. (%) Axillary nodes surgery 600(72)
No. (%) Others 80(10)
No. (%) No information 27(3)
Radiotherapy
Number of patients who had
radiotherapy
Number of patients (%)
501(100)
Duration from diagnosis to
starting Radiotherapy, in day
Number of patients with data on duration
496
Number of patients without data on duration 5
Mean (SD) 190(104)
Median (IQR) 195(127, 239)
(Min, Max) (5, 582)
No. (%) Duration less or equal to 60 days 65(13)
No. (%) Duration less or equal to 120 days 117(24)
No. (%) Duration less or equal to 180 days 216(44)
Duration from surgery to starting
Radiotherapy, in day
Number of patients who available with
duration 456
Number of patients who not available with
date radiotherapy 10
Mean (SD) 165(83)
Median (IQR) 174(104, 209)
(Min, Max) (0, 581)
No. (%) Duration less or equal to 60 days 63(14)
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No. (%) Duration less or equal to 120 days 124(27)
No. (%) Duration less or equal to 180 days 245(54)
Type of Radiotherapy treatment No (%) Whole breast external irradiation 193(39)
No (%) Tumour bed (boost) irradiation 67(14)
No (%) Brachytherapy 0(0)
No (%) Partial breast external irradiation 0(0)
No (%) Intra-operative radiotherapy 0(0)
No (%) Others 264(62)
Radiotherapy treatment regimen Number of patients who do not have total
dose 15
Mean Total dose in Gy (SD) 50(203)
Median (IQR) 40(40, 40)
(Min, Max) (6, 4500)
Number of patients who do not have number
of fractions 15
Mean Number of fractions (SD) 16(5)
Median (IQR) 15(15, 15)
(Min, Max) (1, 30)
Number of patients who do not durations 18
Mean duration in weeks (SD) 3(1)
Median (IQR) 3(3, 3)
(Min, Max) (0, 15)
Systemic therapies
Number of patients who had
Systemic therapy
Number of patients
780(100)
Duration from diagnosis to
starting Systemic therapy, in day
Number of patients with data on duration
719
Number of patients without data on duration 60
Mean (SD) 83(84)
Median (IQR) 56(33, 98)
(Min, Max) (0, 654)
No. (%) Duration less or equal to 60 days 389(54)
No. (%) Duration less or equal to 120 days 591(82)
No. (%) Duration less or equal to 180 days 644(89)
Duration from surgery to starting
Systemic therapy, in day
Number of patients who available with
duration 642
Number of patients who not available with
date systemic therapy 100
Mean (SD) 68(70)
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Median (IQR) 46(30, 75)
(Min, Max) (0, 653)
No. (%) Duration less or equal to 60 days 392(61)
No. (%) Duration less or equal to 120 days 526(82)
No. (%) Duration less or equal to 180 days 561(87)
Type of Systemic therapy No (%) Chemotherapy 632(88)
No (%) Hormonal therapy 455(63)
No (%) Targeted therapy 56(8)
Exposure to drug classes of
chemotherapy
No (%) Anthracycline antibiotics
536(85)
No (%) Antimetabolites 478(76)
No (%) Alkylating agents 584(92)
No (%) Vinca alkaloids 7(1)
No (%) Taxane 299(47)
No(%) Platinum compounds 7(1)
No (%) Topoisomerase inhibitors T1 0(0)
No (%) T1 II 0(0)
No (%) Others 81(18)
Exposure to drug classes of
hormonal therapy
No (%) Oestrogen receptor antagonist
387(85)
No (%) Aromatase Inhibitor 63(14)
No (%) Gonadotrophin 3(1)
No (%) Progestogens 0(0)
No (%) Anti Androgens 0(0)
No (%) Others 53(12)
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Table 5.0: Summary of Breast Cancer care performance for Patients diagnosed
in year 2011
# Performance measure Denomin-
ator*
Numer-
ator(%)**
Remarks
1. Pathology report confirming malignancy 931 895(96)
2. Staging within one month of first visit 432 286(66)
3. Documented plan for chemotherapy 635 544(86)
4. Steroids/Serotonin antagonist prescribed 635 No data
5. Radiation therapy for Stage I to III breast
cancer after breast conserving surgery within
1 year of diagnosis 192 123(64)
6. Combination chemotherapy for Stage I to III
ER/PR negative breast cancer within 4
months of diagnosis 218 139(64)
7. Tamoxifen or AI for Stage I to III ER or PR
positive breast cancer within 1 year of
diagnosis 535 336(63)
8. Trastuzumab for Stage I to III HER2 positive
breast cancer within 1 year of diagnosis 202 36(18)
9. Risk adjusted 5-year relative survival
- -
Too early to do
survival analysis
10. Composite score (Not including
Steroids/Serotonin antagonist prescribed) 3145 2359(75)
*Number of eligible patients
** Number (%) of eligible patients whose care adhere with performance measure
Table 5.1: Pathology Report confirming diagnosis for Breast Cancer (BC) patients in year 2011
Pathology report confirming diagnosis Statistics Results
Number of BC patients in the reporting
period
Number of patients
931
Number of BC patients ineligible for
inclusion
Number of patients
0
Number of BC patients included in this
analysis
Number of patients (%)
931(100)
Number of BC patients whose care met
performance standard
Number of patients (%)
895(96)
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Table 5.2: Staging within one month of first visit for Breast Cancer (BC) patients in year 2011
Staging within one month of first visit Statistics Results
Number of BC patients in the reporting
period
Number of patients
931
Number of BC patients excluded because
staging was NOT conducted in reporting
centre
Number of patients
499
Number of BC patients ineligible for
inclusion for other reasons
Number of patients
0
Number of BC patients included in this
analysis
Number of patients (%)
432(100)
Number of BC patients whose care met
performance standard
Number of patients (%)
286(66)
Table 5.3: Documented plan for chemotherapy for Breast Cancer (BC) patients in year 2011
Documented plan for chemotherapy Statistics Results
Number of BC patients in the reporting
period
Number of patients
931
Number of BC patients excluded because
chemotherapy was NOT administered in
reporting centre
Number of patients
0
Number of BC patients excluded because
chemotherapy was NOT indicated in
reporting centre
Number of patients
296
Number of BC patients ineligible for
inclusion for other reasons
Number of patients
0
Number of BC patients included in this
analysis
Number of patients (%)
635(100)
Number of BC patients whose care met
performance standard
Number of patients (%)
544(86)
Table 5.4: Steroids/Serotonin antagonist prescribed for moderate/high emetic risk chemotherapy for Breast Cancer (BC) patients in year 2011
Steroids/Serotonin antagonist
prescribed for moderate/high emetic
risk chemotherapy
Statistics Results
Number of BC patients in the reporting
period
Number of patients
931
Number of BC patients excluded because
chemotherapy was NOT administered in
Number of patients
0
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reporting centre
Number of BC patients excluded because
chemotherapy was NOT indicated in
reporting centre
Number of patients
296
Number of BC patients with
contraindication to Steroids/Serotonin
antagonist
0
Number of BC patients ineligible for
inclusion
Number of patients
0
Number of BC patients included in this
analysis
Number of patients (%)
635(100)
Number of BC patients whose care met
performance standard
Number of patients (%)
No data
Table 5.5: Radiation therapy for Stage I to III breast cancer after breast conserving surgery within 1 year of diagnosis for Breast Cancer (BC) patients in year 2011
Radiation therapy for Stage I to III
breast cancer after breast conserving
surgery within 1 year of diagnosis
Statistics Results
Number of BC patients in the reporting
period
Number of patients
931
Number of BC patients excluded because
radiotherapy was NOT administered in
reporting centre
Number of patients
0
Number of BC patients with
contraindication to Radiotherapy, or
other reasons for withholding therapy
Number of patients
0
Number of BC patients who did not have
prior breast conserving surgery
Number of patients
731
Number of BC patients ineligible for
other reasons (Age, Stage)
Number of patients
8
Number of BC patients included in this
analysis
Number of patients (%)
192(100)
Number of BC patients who received
radiation therapy
Number of patients (%)
132(69)
Number of BC patients whose care met
performance standard
Number of patients (%)
123(64)
Duration from diagnosis to starting
Radiotherapy, in day
Mean (SD)
178(96)
Median (IQR) 185(100, 224)
(Min, Max) (24, 511)
No. (%) Duration<= 60 days 17(9)
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17
No. (%) Duration<= 120 days 37(19)
No. (%) Duration <=180 days 63(33)
Table 5.6: Combination chemotherapy for Stage I to III ER/PR negative cancer within 4 months of diagnosis for Breast Cancer (BC) patients in year 2011
Combination chemotherapy for Stage I
to III ER/PR negative breast cancer
within 4 months of diagnosis
Statistics Results
Number of BC patients in the reporting
period
Number of patients
931
Number of BC patients excluded because
chemotherapy was NOT administered in
reporting centre
Number of patients
0
Number of BC patients with
contraindication to Chemotherapy, or
other reasons for withholding therapy
Number of patients
0
Number of BC patients who are ER
positive OR PR positive
Number of patients
652
Number of BC patients ineligible for
other reasons (Age, Stage)
Number of patients
61
Number of BC patients included in this
analysis
Number of patients (%)
218(100)
Number of BC patients who received
chemotherapy
Number of patients (%)
178(82)
Number of BC patients whose care met
performance standard
Number of patients (%)
139(64)
Duration from diagnosis to starting
Chemotherapy, in day
Mean (SD)
73(75)
Median (IQR) 49(32, 84)
(Min, Max) (3, 400)
No. (%) Duration<= 60 days 94(43)
No. (%) Duration<= 120 days 139(64)
No. (%) Duration <=180 days 147(67)
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Table 5.7: Tamoxifen or AI for Stage I to III ER or PR positive cancer within 1 year of diagnosis for Breast Cancer (BC) patients in year 2011
Tamoxifen or AI for Stage I to III ER
or PR positive breast cancer within 1
year of diagnosis
Statistics Results
Number of BC patients in the reporting
period
Number of patients
931
Number of BC patients excluded because
hormonal therapy was NOT administered
in reporting centre
Number of patients
0
Number of BC patients with
contraindication to Tamoxifen or AI, or
other reasons for withholding therapy
Number of patients
0
Number of BC patients who are ER
negative AND PR negative
Number of patients
281
Number of BC patients ineligible for
other reasons (Age, Stage)
Number of patients
114
Number of BC patients included in this
analysis
Number of patients (%)
535(100)
Number of BC patients who received
Tamoxifen or AI therapy
Number of patients (%)
378(71)
Number of BC patients who received
Tamoxifen or AI therapy within 365 days
of date of diagnosis
Number of patients (%)
336(63)
Duration from diagnosis to starting
Tamoxifen or AI therapy, in day
Mean (SD)
173(96)
Median (IQR) 177(98, 227)
(Min, Max) (5, 618)
No. (%) Duration<= 60 days 56(10)
No. (%) Duration<= 120 days 104(19)
No. (%) Duration <=180 days 180(34)
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Table 5.8: Trastuzumab for Stage I to III HER2 positive cancer within 1 year of diagnosis for Breast Cancer (BC) patients in year 2011
Trastuzumab for Stage I to III HER2
positive breast cancer within 1 year of
diagnosis
Statistics Results
Number of BC patients in the reporting
period
Number of patients
931
Number of BC patients excluded because
targeted therapy was NOT administered
in reporting centre
Number of patients
0
Number of BC patients with
contraindication to Trastuzumab, or other
reasons for withholding therapy
Number of patients
0
Number of BC patients who were HER2
negative
Number of patients
674
Number of BC patients ineligible for
other reasons (Age, Stage)
Number of patients
56
Number of BC patients included in this
analysis
Number of patients (%)
201(100)
Number of BC patients who received
Trastuzumab therapy
Number of patients (%)
44(22)
Number of BC patients whose care met
performance standard (ie received
Trastuzumab with 12 months of
diagnosis)
Number of patients (%)
36(18)
Duration from diagnosis to starting
Trastuzumab therapy, in day
Mean (SD)
144(128)
Median (IQR) 96(46, 223)
(Min, Max) (22, 475)
No. (%) Duration<= 60 days 18(9)
No. (%) Duration<= 120 days 25(12)
No. (%) Duration <=180 days 29(14)
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Appendix: Definition of Performance Measures for Breast Cancer care # Measure Denominator definition Numerator definition
1. Diagnostic
pathology
Inclusion criteria:
Patients with confirmed diagnosis of
primary cancer, any stages
Patient had Pathology report
confirming malignancy
2. Cancer
staging
Inclusion criteria:
Patients with confirmed diagnosis of
primary cancer, any stages
Patient had Staging
documented within one
month of first visit to
reporting centre
3. Chemotherapy
Treatment
plan
Inclusion criteria:
Patients with confirmed diagnosis of
primary cancer, any stages
Patient had documented plan
for chemotherapy, including
doses, route, and time
intervals
4. Anti- emetic
prescribed
Inclusion criteria:
Patients with confirmed diagnosis of
primary cancer, any stages Received
moderate/high emetic risk chemotherapy
Patient received
Corticosteroids and serotonin
antagonist prescribed
5. Radiotherapy/
Median time
to starting
therapy
Inclusion criteria:
Stage I, II, or III
Contraindication to Radiotherapy or other
reasons for withholding therapy
Surgically treated by breast conservation
surgery (surgical excision less than
mastectomy)
Age 18-69 at time of diagnosis
Women
Known or assumed first or only cancer
diagnosis
Primary tumors of the breast
Epithelial malignancy only
All or part of first course of treatment
performed at the reporting facility
Known to be alive within 1 year (365 days)
of diagnosis
Patient under age 70 who had
breast conserving surgery for
breast cancer received
radiation therapy within 1
year (365 days) of date of
diagnosis
6. Chemotherapy
/ Median time
to starting
therapy
Inclusion criteria:
T1c, or Stage II or III
Primary tumor is estrogen receptor (ER)
negative and progesterone receptor (PR)
negative
Age 18-69 at time of diagnosis
Women
Patient received adjuvant
multi-agent (combination)
chemotherapy within 120
days of date of diagnosis
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Known or assumed first or only cancer
diagnosis
Primary tumors of the breast
Epithelial malignancy only
All or part of first course of treatment
performed at the reporting facility
Known to be alive within 4 months (120
days) of diagnosis
7. Hormonal
therapy/
Median time
to starting
therapy
Inclusion criteria:
T1c, or Stage II or III
Primary tumor is estrogen receptor (ER)
positive or progesterone receptor (PR)
positive
Women
Age >=18 at time of diagnosis
Known or assumed first or only cancer
diagnosis
Epithelial malignancy only
All or part of first course of treatment
performed at the reporting facility Known
to be alive within 1 year (365 days) of
diagnosis Exclusion criteria:
Not documented drug name
Patient received Tamoxifen
or Aromatase Inhibitor within
1 year (365 days) of date of
diagnosis
8. Targeted
therapy/
Median time
to starting
therapy
Inclusion criteria:
T1c, or Stage II or III
Primary tumor is HER2 positive
Women
Age >=18 at time of diagnosis
Known or assumed first or only cancer
diagnosis
Epithelial malignancy only
All or part of first course of treatment
performed at the reporting facility
Known to be alive within 1 year (365 days)
of diagnosis
Patient received Trastuzumab
therapy within 1 year (365
days) days of date of
diagnosis
9. Stage specific
Risk adjusted
5-year relative
survival
Patients with confirmed diagnosis of
primary cancer, any stages
Age 15–99 years
Patients who died after cancer
diagnosis