version no: 2.8 healthcare performance measurement page …...number of pages: 21 investigators,...

Version No: 2.8 Healthcare Performance Measurement

& Report for Breast Cancer services

of 21

Ver.Date: 30 Jan 2013 Protocol No.:HR2011-02

1

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]

http://www.hpmrs.com.my/



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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

http://qopi.asco.org/Documents/QOPISpring2012MeasuresSummary_000.pdf

http://www.asco.org/ASCOv2/Practice+%26+Guidelines/Quality+Care/Quality+Measurement+%26+Improvement/ASCO-NCCN+Quality+Measures

http://www.asco.org/ASCOv2/Practice+%26+Guidelines/Quality+Care/Quality+Measurement+%26+Improvement/ASCO-NCCN+Quality+Measures



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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)


(Min, Max) (0, 709)

No. (%) Duration less or equal to 60 days 740(89)



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


radiotherapy

Number of patients (%)

501(100)


starting Radiotherapy, in day


496


Mean (SD) 190(104)

Median (IQR) 195(127, 239)

(Min, Max) (5, 582)




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)




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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)


(Min, Max) (0, 15)

Systemic therapies


Systemic therapy

Number of patients

780(100)


starting Systemic therapy, in day


719


Mean (SD) 83(84)

Median (IQR) 56(33, 98)

(Min, Max) (0, 654)




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)




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


931(100)

Number of BC patients whose care met

performance standard


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


period

Number of patients

931

Number of BC patients excluded because

staging was NOT conducted in reporting

centre

Number of patients

499


inclusion for other reasons

Number of patients

0


analysis


432(100)




286(66)

Table 5.3: Documented plan for chemotherapy for Breast Cancer (BC) patients in year 2011

Documented plan for chemotherapy Statistics Results


period

Number of patients

931


chemotherapy was NOT administered in

reporting centre

Number of patients

0


chemotherapy was NOT indicated in

reporting centre

Number of patients

296


inclusion for other reasons

Number of patients

0


analysis


635(100)




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


period

Number of patients

931



Number of patients

0



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reporting centre


chemotherapy was NOT indicated in

reporting centre

Number of patients

296

Number of BC patients with

contraindication to Steroids/Serotonin

antagonist

0


inclusion

Number of patients

0


analysis


635(100)




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


period

Number of patients

931


radiotherapy was NOT administered in

reporting centre

Number of patients

0


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


other reasons (Age, Stage)

Number of patients

8


analysis


192(100)

Number of BC patients who received

radiation therapy


132(69)




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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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


period

Number of patients

931



reporting centre

Number of patients

0


contraindication to Chemotherapy, or


Number of patients

0

Number of BC patients who are ER

positive OR PR positive

Number of patients

652



Number of patients

61


analysis


218(100)


chemotherapy


178(82)




139(64)


Chemotherapy, in day

Mean (SD)

73(75)

Median (IQR) 49(32, 84)

(Min, Max) (3, 400)






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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


period

Number of patients

931


hormonal therapy was NOT administered

in reporting centre

Number of patients

0


contraindication to Tamoxifen or AI, or


Number of patients

0

Number of BC patients who are ER

negative AND PR negative

Number of patients

281



Number of patients

114


analysis


535(100)


Tamoxifen or AI therapy


378(71)


Tamoxifen or AI therapy within 365 days

of date of diagnosis


336(63)


Tamoxifen or AI therapy, in day

Mean (SD)

173(96)

Median (IQR) 177(98, 227)

(Min, Max) (5, 618)






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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


period

Number of patients

931


targeted therapy was NOT administered

in reporting centre

Number of patients

0


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 patients

56


analysis


201(100)


Trastuzumab therapy


44(22)


performance standard (ie received

Trastuzumab with 12 months of

diagnosis)


36(18)


Trastuzumab therapy, in day

Mean (SD)

144(128)

Median (IQR) 96(46, 223)

(Min, Max) (22, 475)






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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:



Patient had Staging

documented within one

month of first visit to

reporting centre

3. Chemotherapy

Treatment

plan

Inclusion criteria:



Patient had documented plan

for chemotherapy, including

doses, route, and time

intervals

4. Anti- emetic

prescribed

Inclusion criteria:


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



of 21


21


diagnosis

Primary tumors of the breast




Known to be alive within 4 months (120

days) of diagnosis

7. Hormonal

therapy/

Median time

to starting

therapy

Inclusion criteria:


Primary tumor is estrogen receptor (ER)

positive or progesterone receptor (PR)

positive

Women

Age >=18 at time of diagnosis


diagnosis



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:


Primary tumor is HER2 positive

Women

Age >=18 at time of diagnosis


diagnosis




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



Age 15–99 years

Patients who died after cancer

diagnosis