Quality measures for breast cancer surgery

kira66715

This week's JAMA looked at re-excision as a quality measure for breast cancer surgery, and decided it wasn't applicable, but here is the editorial:

Although the treatment of cancer is increasingly multimodal, virtually all patients with solid tumors undergo surgery. In breast cancer, survival after mastectomy, or breast-conserving surgery (BCS) and radiotherapy, are equivalent,1​ and both surgical approaches have a negligible risk of major adverse events. Surgical quality performance measures for cancer have generally focused on 30-day morbidity and mortality rates for higher-risk procedures such as pancreatectomy and esophagectomy.2 Thus, breast surgery has largely been excluded from the cancer surgical procedures for which quality measures have been developed. Indeed, the focus of quality improvement in breast cancer has primarily been on process measures tied to nonsurgical treatments, including systemic therapies and radiation.3​ 

The final paragraph:

The focus of McCahill et al6​ on potential surgical overtreatment in breast cancer is important. Advances in the understanding of tumor biology and the availability of increasingly effective targeted therapies make this an ideal time to reconsider approaches to locoregional management. In particular, the substantial increase in the diagnosis of breast cancer with relatively favorable prognosis has motivated a number of initiatives to reduce the burden and morbidity of locoregional treatment in selected subsets of patients. These initiatives are (1) omitting axillary dissection in women with metastases in 1 or 2 sentinel nodes who are undergoing treatment with whole-breast irradiation and systemic therapy,17 (2) the study of partial breast irradiation in subsets of patients known to be at low risk for local recurrence,18​ and (3) research that addresses the causes and consequences of the increasing use of contralateral prophylactic mastectomy in the modern era.19 In this context, quality measures include not only the application of appropriate treatment, but also the avoidance of unnecessary or unproven evaluative tests and treatments. Although it may be premature to determine quality indicators for the strategies targeting reduction of therapy for favorable patient groups, any proposed quality measures must be evidence based and relevant to the current understanding of breast cancer biology, and the subset of patients for whom the measure applies must be rigorously defined for those measures to be useful to clinicians and beneficial to patients.  

So, quality measures of breast cancer surgery aren't defined as it's considered low risk, but the surgery and radiation can create long term "burden and comorbity"

Yeah, few women die on the table during breast surgery, but the long term side effects are significant.

Kira

carol57

Burden hardly begins to describe what a lot of women in this LE forum contend with in the gift that is LE.