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Guideline-concordant treatment predicts survival: a National Cancer Database validation study of novel composite locoregional and systemic treatment scores among women with early stage breast cancer

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Abstract

Background

The aim of this large nationwide study was to validate two novel composite treatment scores that address guideline-concordant locoregional and systemic breast cancer care. We examined the relationship between these two scores and their association with survival.

Methods

Women with Stage I–III unilateral breast cancer were identified within the National Cancer Database. For each woman, a locoregional and a systemic treatment score (0, 1, 2) was assigned based on receipt of guideline-concordant care. Multivariable Cox regression models evaluated the association between the scores and survival.

Results

623,756 women were treated at 1,221 different American College of Surgeons Commission on Cancer (CoC) facilities. Overall, 86% had a locoregional treatment score of 2 (most guideline-concordant), 75% had a systemic treatment score of 2, and 72% had both scores of 2. Median follow-up was 4.5 years. Compared to women with a locoregional treatment score of 2, those with a score of 1 or 0 had a 1.7-fold and 2.0-fold adjusted greater risk of death. Compared to women with a systemic treatment score of 2, those with a score of 1 or 0 had a 1.5-fold and 2.1-fold adjusted greater risk of death. Risk-adjusted 5-year overall survival was 91.6% when both scores were 2 compared to 73.4% when both scores were 0.

Conclusions

In this large national study of CoC facilities, two composite scores capturing guideline-concordant breast cancer care had independent and combined robust effects on survival. These clinically constructed novel scores are promising tools for health services research and quality-of-care studies.

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Authors and Affiliations

  1. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Tina W. F. Yen

  2. Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA

    Purushottam W. Laud & Liliana E. Pezzin

  3. Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

    Ann B. Nattinger

  4. Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA

    Tina W. F. Yen, Zhu** Garacci, Purushottam W. Laud, Liliana E. Pezzin & Ann B. Nattinger

  5. Division of Surgical Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA

    Tina W. F. Yen

Authors
  1. Tina W. F. Yen
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  2. Zhu** Garacci
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Corresponding author

Correspondence to Tina W. F. Yen.

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Conflict of interest

All authors (Yen, Garacci, Laud, Pezzin, Nattinger) declare no conflicts of interest.

Research involving human participants and ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective study, formal informed consent is not required. This de-identified database study (PRO00030472) was determined that it does not meet criteria for human subject research at 45 CFR 46.102 by the Medical College of Wisconsin/Froedtert Hospital Institutional Review Board #5.

Informed consent

A waiver of the informed consent process was granted by the institutional IRB as this is a retrospective, de-identified database study that contains no Protected Health Information (PHI) and does not involve interactions or interventions with living human beings. The waiver of informed consent does not adversely affect the rights and welfare of the subjects and it would not be practical to conduct the research without a waiver.

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Yen, T.W.F., Garacci, Z., Laud, P.W. et al. Guideline-concordant treatment predicts survival: a National Cancer Database validation study of novel composite locoregional and systemic treatment scores among women with early stage breast cancer. Breast Cancer 28, 698–709 (2021). https://doi.org/10.1007/s12282-020-01206-9

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  • DOI: https://doi.org/10.1007/s12282-020-01206-9

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