Adherence to Quality Indicators and Survival in Patients with Breast Cancer
When breast cancer patients are diagnosed and treated in complete accordance with widely accepted standards of care, they survive longer and have better overall outcomes, according to this first study linking the process of care to improved outcomes in breast cancer patients.
Although there are widely accepted standards for breast cancer diagnosis and treatment, studies have shown the care of many women does not completely meet these standards. This prospective study followed 1,378 breast cancer patients newly diagnosed from 1995-2001 at the sole Taiwanese cancer hospital, tracking 10 indicators of care quality and assessing the progress of disease for as long as possible ending June 2007.
- Adherence to all 10 quality indicators by 100 percent of patients, was associated with better overall and progression-free survival.
- Adherence to either the four treatment indicators, or the six diagnostic indicators by 100 percent of the patients, was also associated with statistically significant improvements in survival.
- Improved survival was seen in patients in all age groups
- Improvements in survival were more substantial for those with more severe disease.
This study is limited by its focus on one institution in Taiwan, so results may not be generalizable. Also, information on comorbidities which could bias results was not collected. But the study does provide scientific evidence that 100 percent adherence to established diagnostic and treatment standards does provide better outcomes and may be just as important as introducing new breast cancer treatments. Practitioners need to make it a priority that patients’ care adheres to these quality standards; these standards of care need to be periodically reviewed and updated to incorporate new knowledge.
In addition, this study is one of the first establishing a link between quality of care and outcomes in a group of patients undergoing treatment for any disease. Establishing this link may be crucial to ensure performance measures result in better care as pay-for-performance systems are created.