Ellis Fischel Cancer Center Registry Data Public Reporting of Outcomes: Breast Cancer

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1 Ellis Fischel Cancer Center Registry Data 13 Public Reporting of Outcomes: Breast Cancer To satisfy Standard 1.12 of the American College of Surgeons Commission on Cancer, a review of outcomes related to care of patients with breast cancer was reviewed. The National Cancer Data Base () was a used as the source of data to compare the patient characteristics and survival data for breast cancer cases. The findings are presented below: Age at Diagnosis % Ellis Fischel Cancer Center n= % % 15% % 5% % Under and over National Cancer Database n= This data reveals that the women diagnosed with breast cancer at Ellis Fischel Cancer Center were diagnosed at younger ages when compared to those nationally. This institution had higher rates of cases diagnosed in all age groups depicted except for those groups at aged or above. First Course of Surgery A review of the Ellis Fischel registry data regarding the first course of surgery for the breast cancer patients diagnosed between 3 and 5 shows that more women chose to have mastectomy versus lumpectomy when compared to the national data. One contributing factor to this may be the rural locations that many of our patients reside in and the potential difficulty of traveling to a radiation facility. Ellis Fischel also had a slightly higher percentage of women that chose to have no surgery.

2 Ellis Fischel Cancer Center compared to the National Cancer Database First Course Surgery of Breast Cancer 3-5 % % % % % Ellis Fischel Cancer Center n=1776 National Cancer Database n= % % No Surgery Partial Mastectomy Simple Mastectomy Modified Radical Mastectomy Radical mastectomy, NOS Other Surgery Unknown if Surgery Performed Stage of Breast Cancer The stage of breast cancer at the time of diagnosis for patients at Ellis Fischel was compared to teaching hospitals throughout the country and also to those in the National Cancer Data Base for the years of -. More women were diagnosed with stage II and III breast cancer at this cancer center when compared to other teaching hospitals and the. Ellis Fischel also saw fewer cases of stage breast cancer during this time. Prior research has shown that the further away a woman lives from a mammography facility, the more likely she is to be diagnosed with more advanced disease. Although Ellis Fischel did not see more cases of stage IV disease when compared to the national data, this could be a factor in the increased numbers of stage II and III disease, as many of our patients are from rural populations where there is more limited access to mammography. To help combat the issue of access to mammography in Missouri s rural communities, Ellis Fischel Cancer Center does have a mobile mammography van that travels to 27 mid-missouri counties and to 55 different locations to provide digital mammography, clinical breast exams, and breast health education.

3 Five Year Survival A review of the five year survival data from 3-5, when compared to the shows that the survival for patients with stages I, II and III breast cancer at Ellis Fischel Cancer Center is slightly lower. However, survival for those patients with the most advanced breast cancer (stage IV) was approximately 11% higher at Ellis Fischel when compared to the national data. Perhaps this is related to better access to medical oncology and clinical trials. Ellis Fischel Cancer Center () vs. National Cancer Database () Observed Survival for Stage n=91 n=776 43

4 Ellis Fischel Cancer Center () vs. National Cancer Database () Observed Survival for Stage I Breast Cancer 3-5 n=176 n= Ellis Fischel Cancer Center () vs. National Cancer Database () Observed Survival for Stage II n=116 n=113 8

5 Ellis Fischel Cancer Center () vs. National Cancer Database () Observed Survival for Stage III Breast Cancer n=67 n=43 66 Ellis Fischel Cancer Center () vs. National Cancer Database () Observed Survival for Stage IV Breast Cancer n=18 n=1536 2

6 The Impact of a Dedicated Breast Center on Clinical Outcomes Objectives: Clinical outcomes continue to be a major focus of medical payers. The development of clinical centers of excellence to positively affect clinical outcomes is becoming more prevalent for health care providers. As a large tertiary referral institution we developed a dedicated breast center to improve patient care delivery and positively affect clinical outcomes. This retrospective review evaluates the clinical outcomes of patients with breast cancer treated at our institution prior to and after the establishment of our dedicated Breast Center. Introduction: University of Missouri Health Care/ Ellis Fischel Cancer Center provided the necessary resources to develop a dedicated breast center to meet the multi-faceted needs of our patients. This dedicated breast center became operational in August 5. In September 8 funds were available for the addition of a nursing and radiology patient navigator. Patient navigation has received tremendous attention in the oncology literature as health care organizations strive to streamline care and identify and address gaps in patient care delivery. Previous research and outcomes data has supported the value of the nurse navigator role in oncology care. This data provided support for the navigation roles at our cancer center. The treatment navigator provides extensive education to all newly diagnosed breast cancer patients, coordinates the multi-disciplinary breast cancer conference, coordinates multi-disciplinary appointments, and identifies and addresses any barriers for the patient regarding the cancer or treatment plan throughout the trajectory of treatment and beyond. Method: Cancer Registry and chart review data of breast cancer cases was conducted during three separate time periods: Jan-June 5 (prior to breast center formation), Jan-June of 8 (1 year after opening of breast center), and Jan-June (3 years after opening of the breast center with the nurse and radiology navigator in place). The Advisory Board 9 Tumor Site Dashboard for Breast Cancer was utilized as the source of stated benchmarks/outcomes. Results: The following chart represents the benchmarks evaluated and the respective outcomes during the indicated time frames: Indicator/Benchmark Jan-June 5 Jan-June 8 Jan-June Time from reporting of abnormal mammogram results to diagnostic mammogram (average days) Time from reporting of diagnostic mammogram results to needle biopsy (average 19 days) 16.5 days 15.4 days 5.4 days.7 days.6 days 5.25 days

7 Percent of patients called back for follow-up studies due to abnormal findings (average 13.1%).86% 8.92% 9.52% Percent of mastectomy patients undergoing SN biopsy (expected %) % % 95% Percent of DCIS patients receiving mastectomy who also undergo SLN biopsy (expected %) 32% % 52% Percent of patients receiving breast conserving therapy vs. mastectomy (national average 65%) Lumpectomy: 54% Mastectomy: 46% Lumpectomy: 58% Mastectomy: 42% Lumpectomy: 62% Mastectomy: 38% Re-excision rates due to positive margins 17% 8% 16% Percent of patients receiving radiation following lumpectomy (expected %) 71% 92% 92% Conclusions: Most of the benchmarks investigated showed a dramatic increase in performance. Mammography call back times and time from diagnostic mammogram to diagnosis were much improved in the breast center setting. An increase in breast conserving therapy was also demonstrated. The development of our multidisciplinary breast center has required a significant dedication from our institution and health care providers. The addition of a diagnostic nurse navigator, which occurred in June of 8, has also positively impacted patient outcomes. The dedication of resources in developing our breast center has positively impacted patient care delivery and outcomes at our institution.