Do the CMS proposed breast cancer quality measures actually predict improved outcomes?
BACKGROUND
In 2007, professional collaborations developed a unified set of quality standards for breast cancer care.


METHODS
This was an Institutional Review Board-approved, retrospective review of all breast cancer patients treated initially at University of Oklahoma Medical Center from 2000 to 2008. All tumor registry data were reviewed to test compliance with the Center for Medicare and Medicaid Services (CMS) (Medicare) quality standards.


RESULTS
Overall and disease-free survival was better for patients meeting the radiation for breast conservation standard (P < .02). Whether estrogen receptor positive (ER+) or estrogen receptor negative, there were similar statistically significant benefits of combination chemotherapy in overall and disease-free survival rates for all patients with tumors greater than 1 cm in size (P < .05). Hormonal therapy was associated with an overall survival benefit (P < .005) but only a trend toward improvement in disease-free survival (P = .076).


CONCLUSIONS
We believe the current CMS standards are a reasonable first step at monitoring breast cancer quality of care. Our data suggest that these may be improved by including combination chemotherapy in ER+ disease when data show a net survival benefit over hormonal therapy alone.
Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA. william-dooley@ouhsc.edu
William
W
Dooley
Ronald
R
Squires
Jingu
J
Bong
Jeanene
J
Parker
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000191:economics* / Q000401:mortality / Q000628:therapy; D003131:Combined Modality Therapy / Q000592:standards; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D011379:Prognosis; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D055815:Young Adult