title: Variations in compliance to quality indicators by age for 41,871 breast cancer patients across Europe: a European Society of Breast Cancer Specialists database analysis.
abstract: OBJECTIVE
  The aim of this study is to assess age-specific compliance to quality indicators (QIs) regarding the treatment of breast cancer as defined by European Society of Breast Cancer Specialists (EUSOMA) for patients across Europe.
  
  
  METHODS
  All patients entered into this study were affected by in situ or invasive breast cancer, diagnosed and treated between 2003 and 2012 at 27 Breast Units across Europe, who were entered into the EUSOMA database. Patients were categorised according to age; compliance to thirteen QIs was assessed for each age group and per time period (2003-2007 and 2008-2012). Compliance to QIs was tested by multivariable logistic regression models adjusted for breast unit, incidence year and tumour characteristics.
  
  
  RESULTS
  Overall, 41,871 patients with a mean age of 59.6years were available for analysis. The highest compliance was reached for patients aged 55-64years and in the time period 2008-2012, whilst the lowest compliance was observed for women aged over 74 or under 40years and in the earlier time period. In multivariable logistic regression models, a significant difference between age categories was shown for 12 out of 13 QIs (P<0.001). Compliance to the QIs for patients aged ⩾75years was significantly lower when compared to patients aged 55-64years for ten QIs, whilst for patients in the youngest age group this was true for seven QIs.
  
  
  CONCLUSIONS
  In conclusion, we found that among the 27 included breast units across Europe, compliance to QIs for breast cancer treatment is often lower in the youngest and oldest breast cancer patients, with a tendency to overtreatment in the youngest patients, and to under-treatment in the elderly.
authors.affiliation: European Registration of Cancer Care (EURECCA), Leiden, The Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Geriatrics and Gerontology, Leiden University medical Center, Leiden, The Netherlands.
authors.forename: Mandy
authors.initials: M
authors.lastname: Kiderlen
authors.affiliation: European Society of Breast Cancer Specialists (EUSOMA), Italy; CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ponti
authors.affiliation: European Society of Breast Cancer Specialists (EUSOMA), Italy; CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy.
authors.forename: Mariano
authors.initials: M
authors.lastname: Tomatis
authors.affiliation: European Registration of Cancer Care (EURECCA), Leiden, The Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Petra G
authors.initials: PG
authors.lastname: Boelens
authors.affiliation: European Registration of Cancer Care (EURECCA), Leiden, The Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands; Department of Geriatrics and Gerontology, Leiden University medical Center, Leiden, The Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: Bastiaannet
authors.affiliation: European Society of Breast Cancer Specialists (EUSOMA), Italy; Department of Radiology, Royal Marsden Hospital, London, United Kingdom.
authors.forename: Robin
authors.initials: R
authors.lastname: Wilson
authors.affiliation: European Registration of Cancer Care (EURECCA), Leiden, The Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: c.j.h.van_de_velde@lumc.nl.
authors.forename: Cornelis J H
authors.initials: CJ
authors.lastname: van de Velde
authors.affiliation: European Registration of Cancer Care (EURECCA), Leiden, The Netherlands; European Society of Breast Cancer Specialists (EUSOMA), Italy; Department of Surgery, St Helens Teaching Hospital, St Helens, United Kingdom; University of Liverpool, Liverpool, United Kingdom.
authors.forename: Riccardo A
authors.initials: RA
authors.lastname: Audisio
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D016208:Databases, Factual; D005060:Europe; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008495:Medical Oncology / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care
keywords: Breast cancer; Epidemiology; Quality indicators; Quality of care