E36: Commission on Cancer Center Performance with Timeliness of Breast Cancer Treatment Quality Measures

Introduction:
The Commission on Cancer (CoC) developed two new breast cancer timeliness quality measures: surgery ≤ 60 days from diagnosis, and radiotherapy ≤60 days from breast-conserving surgery. This study assesses facility factors associated with low performance of these metrics.


Methods:
The National Cancer Database was used to retrospectively examine the proportion of breast cancer patients treated within 60 days using estimated performance rate (EPR) levels of 70%, 80% and 90%. Median days from diagnosis to surgery in a non-neoadjuvantly treated patient population and days from breast-conserving surgery to radiation were examined for AJCC Stage I-III breast cancer patients between 2004-2020. Facility factors associated with a lower performance were analyzed using multivariable logistic regression analysis.


Results: In total, 1,331 CoC facilities were included for the surgery measure and 1,320 CoC facilities were included for the radiation measure. The median number of days from diagnosis to surgery was 16 in 2004 and 34 in 2020 (p< 0.01) (Figure 1a). The median number of days from breast-conserving surgery to radiation was 43 in 2004 and 48 in 2020 (p< 0.01) (Figure 1b). For the surgery and radiation measures, the proportion of facilities that performed at an 80% EPR was 92.3% and 49.8% in 2004 compared to 69.6% and 39.4% in 2020, respectively. For the surgery measure between 2016 and 2020, 1,195 facilities (90.9%) performed at an EPR of 70%, 950 facilities (72.2%) at 80% EPR, and 448 (34.1%) at 90% EPR. For radiation from 2016-2020, 830 facilities (64.0%) performed at 70% EPR, 456 facilities (35.2%) at 80% EPR, and 115 facilities (8.90%) at 90% EPR. On multivariable analysis, facility factors associated with greater than two times the odds of performance below an EPR of 80% for the surgery measure was having >10% of patients on Medicaid (OR 2.63, CI 1.78-3.88, p< 0.01) and >30% of patients being diagnosed at a different facility (OR 2.58, CI 1.94-3.43, p< 0.01). For the radiation measure with an EPR of 80%, the factors associated with greater than two times risk for low performance were being an academic center (OR 2.41, CI 1.69-3.44, p< 0.01), having >10% of patients on Medicaid (OR 3.04, CI 2.02-4.58, p< 0.01), and ≥5% of patients living in a rural area (OR 2.13, CI 1.51-3.01, p< 0.01).

Conclusions:
Time to surgery has more than doubled over the past 15 years. Facilities with a higher proportion of Medicaid patients are at high risk of poor performance with both measures, suggesting that time to treatment represents a potential quality improvement opportunity for CoC centers with socioeconomically disadvantaged patients.