title: Using the National Cancer Data Base for quality evaluation to assess adherence to treatment guidelines for nonmetastatic inflammatory breast cancer.
abstract: BACKGROUND
  Guidelines for the treatment of nonmetastatic inflammatory breast cancer (IBC) using trimodality therapy (TT) (chemotherapy, surgery, and radiotherapy) have remained largely unchanged since 2000. However, many patients with nonmetastatic IBC do not receive TT. It is unknown how patient-level (PL) and facility-level (FL) factors contribute to TT use.
  
  
  METHODS
  Using the National Cancer Data Base, patients with nonmetastatic IBC who underwent locoregional treatment from 2003 through 2011 were identified. The authors correlated PL factors, including demographic and tumor characteristics, with TT use. An observed-to-expected ratio for the number of patients treated with TT was calculated for each hospital by adjusting for significant PL factors. Hierarchical mixed effects models were used to assess the percentage of variation in TT use attributable to PL and FL factors, respectively.
  
  
  RESULTS
  Of the 542 hospitals examined, 55 (10.1%) and 24 (4.4%), respectively, were identified as significantly low and high outliers for TT use (P<.05). The percentage of the total variance in the use of TT attributable to the facility (11%) was nearly triple the variance attributable to the measured PL factors (3.4%). The nomogram generated from multivariate logistic regression of PL factors only allows a facility to assess TT use given their PL data.
  
  
  CONCLUSIONS
  FL factors rather than PL factors appear to contribute disproportionately to the underuse of TT in patients with nonmetastatic IBC. To improve treatment guideline adherence for patients with nonmetastatic IBC, it is critical to identify the specific FL factors associated with TT underuse. More organized FL intervention is required to train physicians and to build multidisciplinary teams. Cancer 2017;123:2618-25. © 2017 American Cancer Society.
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Heather Y
authors.identifier: http://orcid.org/0000-0002-1779-7007
authors.initials: HY
authors.lastname: Lin
authors.affiliation: Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bedrosian
authors.affiliation: Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.|Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Gildy V
authors.initials: GV
authors.lastname: Babiera
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Simona F
authors.initials: SF
authors.lastname: Shaitelman
authors.affiliation: Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Henry M
authors.initials: HM
authors.lastname: Kuerer
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Woodward
authors.affiliation: Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas.|Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Naoto T
authors.initials: NT
authors.lastname: Ueno
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Yu
authors.initials: Y
authors.lastname: Shen
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002173:Cancer Care Facilities; D002277:Carcinoma / Q000473:pathology / Q000628:therapy*; D016208:Databases, Factual; D005260:Female; D019983:Guideline Adherence; D006764:Hospitals, Community; D006801:Humans; D058922:Inflammatory Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D016015:Logistic Models; D008408:Mastectomy; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D011878:Radiotherapy; D012189:Retrospective Studies; D014481:United States
chemical_list: D000970:Antineoplastic Agents
keywords: adherence to treatment guidelines; facility-level factors; nonmetastatic inflammatory breast cancer (IBC); patient- and facility-level factors; trimodality treatment