title: National Evaluation of the New Commission on Cancer Quality Measure for Postmastectomy Radiation Treatment for Breast Cancer.
abstract: Current guidelines recommend postmastectomy radiotherapy (PMRT) for patients with ≥4 positive lymph nodes and suggest strong consideration of PMRT in those with 1-3 positive nodes. These recommendations were incorporated into a Commission on Cancer quality measure in 2014. However, national adherence with these recommendations is unknown. Our objectives were to describe PMRT use in the United States in patients with stage I to III invasive breast cancer and to examine possible factors associated with the omission of PMRT.
  
  
  
  From the National Cancer Data Base, 753,536 mastectomies at 1123 hospitals were identified from 1998 to 2011. PMRT use over time was examined using random effects logistic regression analyses, adjusting for patient, tumor, and hospital characteristics. Analyses were stratified by nodal status (≥4 nodes positive, 1-3 nodes positive, node negative).
  
  
  
  The proportion of patients receiving PMRT increased from 1998 to 2011 (>4 positive nodes: 56.2 to 66.6 %; 1-3 positive nodes: 28.0 to 39.1 %; node-negative: 8.3 to 10.0 %, p < 0.001 for all). In adjusted analyses, patients with ≥4 positive nodes were more likely to have PMRT omitted if they had smaller tumors. Patients with 1-3 positive nodes were more likely to have PMRT omitted if they had lower grade or smaller tumors. Irrespective of patients' nodal status, PMRT utilization rates decreased as age increased.
  
  
  
  Though PMRT rates increased over time in patients with ≥4 and 1-3 positive nodes, PMRT in patients with ≥4 positive nodes remains underutilized. Feedback to hospitals using the new Commission on Cancer PMRT measure may help to improve adherence rates.
authors.affiliation: Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University and Northwestern Memorial Hospital, Chicago, IL, USA. christina-minami@northwestern.edu.|Robert H. Lurie Comprehensive Cancer Center, Northwestern Institute for Comparative Effectiveness Research in Oncology, Northwestern University and Northwestern Memorial Hospital, Chicago, IL, USA. christina-minami@northwestern.edu.|Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. christina-minami@northwestern.edu.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Minami
authors.affiliation: Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University and Northwestern Memorial Hospital, Chicago, IL, USA.|Robert H. Lurie Comprehensive Cancer Center, Northwestern Institute for Comparative Effectiveness Research in Oncology, Northwestern University and Northwestern Memorial Hospital, Chicago, IL, USA.|Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.|Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL, USA.
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
authors.affiliation: Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL, USA.|Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Nora M
authors.initials: NM
authors.lastname: Hansen
authors.affiliation: Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL, USA.|Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Strauss
authors.affiliation: Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL, USA.|Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Hayes
authors.affiliation: Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Joe M
authors.initials: JM
authors.lastname: Feinglass
authors.affiliation: Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL, USA.|Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Bethke
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Rydzewski
authors.affiliation: National Cancer Data Base, American College of Surgeons, Chicago, IL, USA.
authors.forename: David P
authors.initials: DP
authors.lastname: Winchester
authors.affiliation: National Cancer Data Base, American College of Surgeons, Chicago, IL, USA.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Palis
authors.affiliation: Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University and Northwestern Memorial Hospital, Chicago, IL, USA.|Robert H. Lurie Comprehensive Cancer Center, Northwestern Institute for Comparative Effectiveness Research in Oncology, Northwestern University and Northwestern Memorial Hospital, Chicago, IL, USA.|Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL, USA.|Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D011785:Quality Assurance, Health Care; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome; D014481:United States