Quality of Cancer Care Measures for Breast and Colorectal Cancer Jointly Released

In a move more than 2 years in the making, a National Quality Forum (NQF) recently endorsed the first nationally recognized hospital-based performance measures for quality of care for breast and colorectal cancer. The pioneering effort was led by the American College of Surgeons (ACoS) Commission on Cancer (CoC), working in concert with the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN). The Commission on Cancer is a consortium of more than 40 professional organizations, including representatives from all medical disciplines that treat and care for cancer patients. The CoC accredits over 1,400 cancer programs across the United States committed to providing the best in cancer care and are able to comply with established standards.

Boosting Public Confidence

"This is an important advancement for the public and for the health-care community because it marks the first time we have nationally accepted measures of quality for treating people with breast and colon cancer," said Stephen Edge, MD, who co-led the ACoS Commission on Cancer's effort. "These measures help close the loop on quality improvement-data collected by hospitals and submitted nationally to the Commission on Cancer can now be used by hospitals and doctors to assess how they perform in comparison to others, and to address any issues in quality. The public can now have confidence that when their hospitals perform well in using these measures, they are receiving the nationally recognized standard of care as put forth by the nation's leading cancer organizations," Dr. Edge explained.

Key Measures

In breast cancer patients, the measures endorsed by the NQF and put forth by the three cancer networks include the following:

• Radiation therapy is administered within 1 year of diagnosis for women under age 70 receiving breast-conserving surgery for breast cancer.

• Combination chemotherapy is considered or administered within 4 months of diagnosis for women under 70 with hormone receptor-negative breast cancer that is either larger than 1 cm with no nodal or distant organ metastasis, or has spread to involve regional lymph nodes but has not metastasized to organs outside the breast.

• Tamoxifen or third-generation aromatase inhibitor is considered or administered within 1 year of diagnosis for women with hormone receptor-positive breast cancer that is either larger than 1 cm with no nodal or distant organ metastasis, or has spread to involve regional lymph nodes but has not metastasized to organs outside the breast.

In patients with colon cancer, a key measure looks at whether postoperative chemotherapy is considered or administered within 4 months of diagnosis for patients under the age of 80 with colon cancer that involves regional lymph nodes.

Important Step Forward

"The endorsement of these new cancer care measures by the National Quality Forum is an important step forward," said Agency for Healthcare Research and Quality director and NQF board member Carolyn M. Clancy, MD. "These measures, championed by leading cancer organizations and others, will help set clear standards for treating breast and colorectal cancer and help patients receive the best care possible."

In developing the measures, the organization members made the deliberate decision to evaluate the performance of hospitals and health-care systems, not individual physicians. "Treating and managing cancer is an interdisciplinary, not a solo, practice; therefore, it was essential that we focused on hospitals and systems," according to Clifford Ko, MD, director, division of research and optimal patient care, American College of Surgeons and co-leader of the initiative.

The standard of care measures for breast and colon disease are posted on the ACoS website at www.facs.org/cancer/qualitymeasures.html. The measures are also on the websites of ASCO (www.asco.org/qualitymeasures) and NCCN (www.nccn.org/). The organizations will proactively distribute the measures to the entire cancer community. The National Quality Forum first issued a call for breast and colorectal measures in 2004 and 2005.