Abstract P2-11-03: Multidisciplinary breast cancer care registry and quality control system in the Netherlands: The NABON breast cancer audit
Authors: Tjan-Heijnen Vivianne C , van Bommel Annelotte C , van der Heiden-van der Loo Margriet , Westenend Pieter , de Vries Bart , Smorenburg Carolien H , Jager Agnes , Lobbes Marc B , Pijnappel Ruud M , Maduro John H , Struikmans Henk , Mureau Marc A , Schrieks Marga , Richel Carol , Schepens Maike , van Dalen Thijs , Wouters Michel W , Vrancken Peeters Marie-Jeanne T , Rutgers Emiel J , Siesling Sabine 
Published: May 2015

Abstract
Background
Previous quality assessments in oncology focused on surgical issues such as number of annual operations per hospital. However, high-quality of care depends on an excellent interplay between all disciplines involved in cancer care. The NABON (National Breast Cancer Organisation of the Netherlands) has, therefore, developed a multidisciplinary set of 30 quality indicators to check and improve breast cancer care. Health insurers have recently decided to use this information for purchasing.
Methods
The NABON Breast Cancer Audit (NBCA) started in 2011. Data on all newly diagnosed patients with invasive breast cancer in the Netherlands are collected by the Netherlands Cancer Registry (n=61 hospitals) or by the physicians themselves (n=31 hospitals). Data capture is facilitated using a web-based portal and feedback to participating hospitals on their own data is being done every week. Since 2012 all Dutch hospitals participate. A set of quality indicators on process and outcome was selected following established clinical guidelines and is being supervised by a multidisciplinary steering committee.
Results
Data of all 41,958 breast cancer patients treated between 2011 and 2013 were collected. In 2013, 94% of patients were discussed in the multidisciplinary team prior to first treatment and 98% after surgery. BI-RADS score was used in 98% of radiological reports. After neo-adjuvant chemotherapy, 7.6% of patients had positive specimen margins following first breast conserving surgery compared to 5.0% and 20% of patients following primary breast conserving surgery for invasive cancer and ductal carcinoma in situ, respectively. Eighteen percent and 36% of patients underwent immediate breast reconstruction after mastectomy for invasive cancer and ductal carcinoma in situ, respectively. Pathological analysis showed 12% of patients had HER2 positive and 85% had ER positive disease. Neo-adjuvant or adjuvant systemic therapy was given to 63% of patients and neo-adjuvant or adjuvant chemotherapy to 39% of patients. Time between diagnosis and first treatment was generally short: 49% to 85% underwent primary surgery with and without immediate reconstruction, respectively, and 76% underwent neo-adjuvant chemotherapy within 5 weeks from first biopsy. At the conference we will show that variation between hospitals was not related to annual surgical volume per hospital.
Conclusion
The NBCA is a unique national system to provide and confirm quality assessment in breast cancer and to drive improvements in quality of multidisciplinary breast cancer care. Present results show an overall high quality of care in the Netherlands and provide insight in items of improvement.
Citation Format: Vivianne C Tjan-Heijnen, Annelotte C van Bommel, Margriet van der Heiden-van der Loo, Pieter Westenend, Bart de Vries, Carolien H Smorenburg, Agnes Jager, Marc B Lobbes, Ruud M Pijnappel, John H Maduro, Henk Struikmans, Marc A Mureau, Marga Schrieks, Carol Richel, Maike Schepens, Thijs van Dalen, Michel W Wouters, Marie-Jeanne T Vrancken Peeters, Emiel J Rutgers, Sabine Siesling. Multidisciplinary breast cancer care registry and quality control system in the Netherlands: The NABON breast cancer audit [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-11-03.