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Publication - Consultation Paper

Breast Cancer Clinical Quality Performance Indicators Engagement Document.

Published: 6 May 2016
ISBN:
9781786522535

Document explaining the process of, and inviting engagement on, revision of the breast cancer QPIs.

37 page PDF

509.7kB

37 page PDF

509.7kB

Contents
Breast Cancer Clinical Quality Performance Indicators Engagement Document.
7. Survival

37 page PDF

509.7kB

7. Survival

Improving survival forms an integral part of the national cancer quality improvement programme. The Breast Cancer QPI Development Group has therefore identified issues which should be addressed within breast cancer survival analysis (see survival QPIs 1 and 2 below).

To ensure consistent application of survival analysis, it has been agreed that a single analyst on behalf of all three regional cancer networks undertakes this work. Survival analysis is scheduled as per the national survival analysis and reporting timetable, agreed with the National Cancer Quality Steering Group and Scottish Cancer Taskforce. This reflects the requirement for record linkage and the more technical requirements of survival analyses which makes it difficult for individual Boards to undertake routinely and in a nationally consistent manner.

Survival QPI 1: Overall 5 year Survival

QPI Title: Overall 5 year survival for Breast Cancer.
Description: 5 year observed (Kaplan Meier) survival estimates for all breast cancer patients in Scotland diagnosed in the relevant year(s).
Rationale and Evidence: Previous studies suggest that population-based survival from breast cancer was lower in Scotland than in some other European countries. Survival from breast cancer has been improving and it is expected that better clinical management will result in better outcomes for patients 19 20 .
Specifications: 5 year observed (Kaplan Meier) survival estimates for all breast cancer patients in Scotland diagnosed in the relevant year(s).
Time to event measured: days between date of diagnosis and date of death.
Patients with no date of death are censored at the latest available confirmed date of death (from GRO(S) linked file).
Ideally, requires case ascertainment in excess of 90%.
Further analysis may be provided depending on clinical relevance e.g.
  • Prognostic indicators e.g. Deprivation
  • Age-standardised estimates
  • Cause-specific analysis
  • Relative survival
Exclusions:
  • Patients with breast lymphoma, sarcoma/phyllodes or in situ disease only.
  • Patients diagnosed at autopsy.
Target: 85%

Survival QPI 2: Overall 5 year survival for patients presenting symptomatically

QPI Title: Overall 5 year survival for Breast Cancer for patients presenting symptomatically.
Description: 5 year observed (Kaplan Meier) survival estimates for all symptomatic breast cancer patients in Scotland diagnosed in the relevant year(s).
Rationale and Evidence: Previous studies suggest that population-based survival from breast cancer was lower in Scotland than in some other European countries. Survival from breast cancer has been improving and it is expected that better clinical management will result in better outcomes for patients. It is likely that screening has contributed to these improvements but it is important that those presenting symptomatically are managed appropriately to ensure the optimum outcome and that units not dealing with screening patients are able to compare their results with those across the country 19 20 .
Specifications: 5 year observed (Kaplan Meier) survival estimates for all symptomatic breast cancer patients in Scotland diagnosed in the relevant year(s).
Time to event measured: The number of days between date of diagnosis and date of death.
Patients with no date of death are censored at the latest available confirmed date of death (from GRO(S) linked file).
Ideally, requires case ascertainment in excess of 90%.
Further analysis may be provided depending on clinical relevance e.g.
  • Prognostic indicators e.g. Deprivation
  • Age-standardised estimates
  • Cause-specific analysis
  • Relative survival
Exclusions:
  • All screen-detected breast cancer patients.
  • Patients with breast lymphoma, sarcoma/phyllodes or in situ disease only.
  • Patients diagnosed at autopsy.
Target: 75%

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