Abstract P4-10-22: Quality indicators in breast cancer care: Experience of a breast cancer multidisciplinary unit at Instituto Nacional de Ciencias Médicas y Nutrición. Dr Salvador Zubirán, (INCMNSZ) Mexico City
Authors: Amengol-Alonso A , Chávarri-Guerra Y , Córtes-González R , Medina-Franco H , Espinoza de los Monteros A , Gamboa-Domínguez A , Candanedo-González F , Flores-Balcazar C , Ramos R , Fuentes-Corona R , Chapa-Ibarguengoitia M , Balboa-González P , Bazúa-Gerez A , León-Rodríguez E 
Published: February 2018

Abstract
Background: In 2012, GLOBOCAN reported that the incidence of BC among Mexican women was 35.4 per 100.000 habitants According to some published studies, the five-year overall survival among Mexican breast cancer patients (BCP) treated at governmental facilities is about 75-80%. As a result of an increased access to oncology treatments, multidisciplinary breast cancer units (MBCU) have been developed all over the country aiming to improve outcomes in BCP, however, to date, information regarding quality of care measured by international criteria is lacking. In 2011 our institution was a pioneer in establishing MBCU The aim of the present study was to describe quality indicators in breast cancer care at our MBCU
Patients and methods: This is a propective study including 357 breast cancer patients Jan 2011 to Dec 2016. 111 variables were recorded for each patient. Based on the 17 items to evaluate quality in BCP of 2008 European Society of Breast Cancer Specialist (EUSOMA), the EUSOMA-based evaluated criteria was: 1) Completeness of clinical and imaging diagnostic work-up, 2) Multidisciplinary discussion, 3) Waiting times, 4) Appropriate surgical approach (breast conservative surgery in IBC ≤ 3 cm), and 5)Post-operative radiotherapy. The analysis was performed using SPSS software v.21.
Results: Three hundred and fifty-five patients were included (99.4% women). The median age was 57 years (P25-75 49-66 years). Stages were classified as: cTNM stage I (32.2%), stage II (34.7%), stage III (10.6%), and stage IV (18.2%). The results of the EUSOMA-based criteria were: 1) 95% of the cohort completed clinical and imaging diagnostic work-up (EUSOMA minimum standard 90%, target 95%, LoE III); 2) a multidisciplinary discussion at the time of diagnosis was established in 97% of BCP (EUSOMA minimum standard 90%, target 99%, LoE IV); 3) the median waiting time from histological diagnosis to primary treatment was 3.8 weeks (median time for surgery and systemic treatment was 4.5 and 1.4 weeks, respectively) (EUSOMA cut point 6 weeks, minimum standard 75%, target 90%, LoE IV); 4) surgical treatment was performed as first-line therapy in 196 BCP (127 (64.6%) conservative surgery and 69 (35.4%) mastectomy) (EUSOMA conservative surgery minimum standard 70%, target 80%, LoE I) 5) 95% of BCP with an indication for adjuvant radiotherapy had a median waiting time of 1.5 weeks (EUSOMA minimum standard 90%, target 95%, LoE I)
Conclusion: According to these results, our MBCU meets the minimum standards of quality in 5 EUSOMA indicators. However, it is important to highlight that our MBCU is small,analyzing 100 new patients/year but comprising with enough infrastructure and staff for this demand; for this reason, real data representing other Mexican or Latin American MBCUs might not be accurate. Furthermore, to increase the quality of breast cancer care, all EUSOMA objectives should be measured (always adapting to the evaluated a breast cancer population) and only in this way areas of opportunity for improvement could be identified. The present study highlights the need to carry out specific research in breast cancer care qualitiy in low and middle income countries.
Citation Format: Amengol-Alonso A, Chávarri-Guerra Y, Córtes-González R, Medina-Franco H, Espinoza de los Monteros A, Gamboa-Domínguez A, Candanedo-González F, Flores-Balcazar C, Ramos R, Fuentes-Corona R, Chapa-Ibarguengoitia M, Balboa-González P, Bazúa-Gerez A, León-Rodríguez E. Quality indicators in breast cancer care: Experience of a breast cancer multidisciplinary unit at Instituto Nacional de Ciencias Médicas y Nutrición. Dr Salvador Zubirán, (INCMNSZ) Mexico City [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-22.