title: Many quality measurements, but few quality measures assessing the quality of breast cancer care in women: a systematic review.
abstract: BACKGROUND
  Breast cancer in women is increasingly frequent, and care is complex, onerous and expensive, all of which lend urgency to improvements in care. Quality measurement is essential to monitor effectiveness and to guide improvements in healthcare.
  
  
  METHODS
  Ten databases, including Medline, were searched electronically to identify measures assessing the quality of breast cancer care in women (diagnosis, treatment, followup, documentation of care). Eligible studies measured adherence to standards of breast cancer care in women diagnosed with, or in treatment for, any histological type of adenocarcinoma of the breast. Reference lists of studies, review articles, web sites, and files of experts were searched manually. Evidence appraisal entailed dual independent assessments of data (e.g., indicators used in quality measurement). The extent of each quality indicator's scientific validation as a measure was assessed. The American Society of Clinical Oncology (ASCO) was asked to contribute quality measures under development.
  
  
  RESULTS
  Sixty relevant reports identified 58 studies with 143 indicators assessing adherence to quality breast cancer care. A paucity of validated indicators (n = 12), most of which assessed quality of life, only permitted a qualitative data synthesis. Most quality indicators evaluated processes of care.
  
  
  CONCLUSIONS
  While some studies revealed patterns of under-use of care, all adherence data require confirmation using validated quality measures. ASCO's current development of a set of quality measures relating to breast cancer care may hold the key to conducting definitive studies.
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, Canada. hschacht@uottawa.ca
authors.forename: Howard M
authors.initials: HM
authors.lastname: Schachter
authors.forename: Vasil
authors.initials: V
authors.lastname: Mamaladze
authors.forename: Gabriela
authors.initials: G
authors.lastname: Lewin
authors.forename: Ian D
authors.initials: ID
authors.lastname: Graham
authors.forename: Melissa
authors.initials: M
authors.lastname: Brouwers
authors.forename: Margaret
authors.initials: M
authors.lastname: Sampson
authors.forename: Andra
authors.initials: A
authors.lastname: Morrison
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.forename: Peter
authors.initials: P
authors.lastname: O'Blenis
authors.forename: Chantelle
authors.initials: C
authors.lastname: Garritty
mesh_terms: D001943:Breast Neoplasms / Q000628:therapy*; D005260:Female; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D016896:Treatment Outcome