Breast cancer in the real world.
Top Line: Breast cancer management varies across the U.S., with some metrics putting you at more risk for litigation.
The Studies: The Commission on Cancer (CoC) has six core quality measures for breast cancer care that span diagnosis, surgery, radiation, and systemic therapy. The first study is a NCDB analysis of regional variations across these CoC measures while assessing for impact on survival. Overall, compliance for 4 of the 6 measures was above the goals established when they were instituted. Unfortunately, both measures pertaining to radiation therapy were below average nationwide. Regional variation in compliance was significant, so much so that geographic region was the only predictive variable. The West and East South-Central U.S. consistently fell below goals, and these variations persisted after controlling for clinical and patient characteristics as well as when comparing only academic and high-volume centers. While still important, variation in care was not associated with any differences in survival. The second study analyzes the LexisNexis legal database to look at patterns of lawsuits pertaining to breast cancer. The majority (60%) were for a delay in diagnosis, and the most common defendant specialties were radiology, surgery, and primary care. Just over half of cases ended in favor of the defendant (doctors), while the other half were split between physician losses and out-of-court settlements. To no surprise, there was also significant regional variation in litigation.
Bottom Line: There is significant variation in compliance with CoC quality measures for breast cancer treatment, and delays in diagnosis are associated with the highest risks of provider litigation. | Kantor, Ann Surg Oncol 2018 & Murphy, Ann Surg Oncol 2018
The Studies: The Commission on Cancer (CoC) has six core quality measures for breast cancer care that span diagnosis, surgery, radiation, and systemic therapy. The first study is a NCDB analysis of regional variations across these CoC measures while assessing for impact on survival. Overall, compliance for 4 of the 6 measures was above the goals established when they were instituted. Unfortunately, both measures pertaining to radiation therapy were below average nationwide. Regional variation in compliance was significant, so much so that geographic region was the only predictive variable. The West and East South-Central U.S. consistently fell below goals, and these variations persisted after controlling for clinical and patient characteristics as well as when comparing only academic and high-volume centers. While still important, variation in care was not associated with any differences in survival. The second study analyzes the LexisNexis legal database to look at patterns of lawsuits pertaining to breast cancer. The majority (60%) were for a delay in diagnosis, and the most common defendant specialties were radiology, surgery, and primary care. Just over half of cases ended in favor of the defendant (doctors), while the other half were split between physician losses and out-of-court settlements. To no surprise, there was also significant regional variation in litigation.
Bottom Line: There is significant variation in compliance with CoC quality measures for breast cancer treatment, and delays in diagnosis are associated with the highest risks of provider litigation. | Kantor, Ann Surg Oncol 2018 & Murphy, Ann Surg Oncol 2018
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