2018 Cancer Annual Report

Standard 1.12 Public Report of Outcomes for 2018

Invasive Breast Cancer Treatment Experience at Methodist Fremont Health

According to data from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute, breast, lung, and colorectal tumors are the three most common malignancies in women with breast cancer accounting for 31% of all new cancer cases. In real numbers this translates into approximately 266,120 case each year with 40,920 cancer related deaths. During the time interval from 2011 through 2015, the SEER data has also revealed that the breast cancer incidence was 126/100,000 and increased at the rate of 0.3% per year between 2011and 2015. (1)

The latest mortality data available from the National Center of Health Statistics fortunately reveals some encouraging trends as well. Breast cancer death rates began to decline in 1990. From 2011 through 2015, breast cancer patients had an age adjusted decrease in mortality rate of 1.6% each year. (2)

In Nebraska, there are approximately 2200 new cases each year. From 2011 through 2015, the incidence rate was 124.1/100,000 and increased by 0.6% each year. The mortality rate has decreased by 2.2% each year during that time interval. In addition to earlier detection, improved breast cancer treatments are responsible for these declining rates. (2)

From 2012 to 2016, there were 186 breast cancer patients treated at Methodist Fremont Health. It represents the most common malignancy in women followed by colorectal and lung in decreasing order of frequency.

Reducing Mortality

To improve outcomes and reduce the mortality from breast cancer, Methodist Fremont Health provides treatment that consistently adherences to nationally recognized evidence - based guidelines.

Treatment planning

Treatment improvements are the primary reason for the declining mortality rate of breast cancer patients. These improvements include the establishment of a process to obtain diagnosis through image guided needle biopsy of highly suspicious breast masses to cause minimal disturbance to the tumor.  This method for obtaining tissue for a diagnosis is important for treatment planning. Most breast cancers can be treated with breast conserving surgery followed by radiation. By obtaining a biopsy without disturbing the breast there is a better chance to perform a lumpectomy and reduce the need for an additional excision and breast distortion.

Treatment plans are developed that incorporate the utilization of radiation therapy, chemotherapy, and hormonal therapy when indicated.

Comprehensive treatment planning for breast cancer patients is provided by a team of cancer specialists that meets weekly to develop a specific treatment plan for each patient based upon their needs and the extent of the disease. This collaborative approach to breast cancer treatment assures each patient that their treatment plan is based upon nationally recognized standards and is delivered in a timely manner to achieve the best possible outcome.

Breast Conserving Therapy and Radiation

Patients who are considering lumpectomy visit with the radiation oncologist to discuss the purpose of the treatment and possible side effects. These pretreatment consultations provide patients with a better understanding of the importance of combining radiation with lumpectomy to achieve better outcomes. At Methodist Fremont Health this educational process has enabled patients who selected breast conserving therapy to achieve a high level of adherence to the treatment standard that requires radiation therapy be combined with lumpectomy.

Chemotherapy and Hormonal Therapy

Other important treatment modalities for the management of breast cancer are adjuvant chemotherapy and hormonal therapy. These treatments reduce the risk of developing metastatic disease which adversely impacts survival rates.

At Methodist Fremont Health, the merits of adjuvant chemotherapy are considered for each case. Recent clinical studies have verified that adjuvant combination chemotherapy provides a significant survival advantage to patients with breast cancer especially if the primary tumor is greater than 1 cm. in diameter. This fact would indicate that some patients with stage 1 disease and most patients with stage 2 and all of stage 3 breast cancer patients would benefit from adjuvant chemotherapy as part of the first course of treatment.

For patients with hormone receptor positive tumors there is ample clinical evidence of the benefit for including Tamoxifen or an aromatase inhibitor in the treatment plan. Through the patient evaluation process each case is considered on an individual basis, and a treatment plan is developed that includes hormone therapy if it is in the best interest of the patient to assure a good outcome.

Quality Measures

The cancer program at Methodist Fremont Health uses information technology and comparative data bases to continuously evaluate, analyze and improve the quality of care provided to breast cancer patients at this facility. Reliable reporting tools have been developed to make certain that breast cancer treatment plans adhere to nationally recognized standards and the plan is completed in a timely manner in order to achieve the best possible outcome for each individual. These quality measures are important steps in a treatment process that are proven to have a positive effect on the outcome of the patient.

The quality measures for breast cancer include:

  • Radiation therapy is administered within one year (365 days) of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer (BCSRT)
  • Image or palpation – guided needle biopsy to the primary site is performed to establish the diagnosis of breast cancer. (nBx)
  • Combination chemotherapy is considered or administered within four months (120 days) of diagnosis for women under 70 with AJCC T1c, or Stage II or III hormone receptor negative breast cancer (MAC)
  • Tamoxifen or third generation aromatase inhibitor is considered or administered within one year (365 days) of diagnosis for women with AJCC T1c or Stage II or III hormone receptor positive breast cancer (HT)

Outcomes

These web based electronic reporting tools also provide aggregate data that permits comparison studies with other hospitals in Nebraska and also nationally. These results are displayed in the following charts.

Quality Measure and performance rates for 2016

Image or palpation – guided needle biopsy to the primary site is performed to establish the diagnosis of breast cancer. (nBx)

  • Expected performance rate: 80%
  • Methodist Fremont Health performance rate: 96.8%
  • Nebraska performance rate: 90.3%

Radiation therapy is administered within one year (365 days) of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer (BCSRT)

  • Expected performance rate: 90%
  • Methodist Fremont Health performance rate: 100%
  • Nebraska performance rate: 93.9%

Combination chemotherapy is considered or administered within four months (120 days) of diagnosis for women under 70 with AJCC T1c, or Stage II or III hormone receptor negative breast cancer (MAC)

  • Expected performance rate: 90%
  • Methodist Fremont Health performance rate: 100%
  • Nebraska performance rate: 97.4%

Tamoxifen or third generation aromatase inhibitor is considered or administered within one year (365 days) of diagnosis for women with AJCC T1c or Stage II or III hormone receptor positive breast cancer (HT)

  • Expected performance: 90%
  • Methodist Fremont Health performance rate: 100%
  • Nebraska performance: 93.5%

Conclusion

The analysis of these performance rates indicates that the patients treated at Methodist Fremont Health are receiving care consistent with nationally recognized evidence - based guidelines at a rate that equals or exceeds the expected performance rates and is consistent with the experience of breast cancer patients from the entire state of Nebraska. The outstanding results achieved by the cancer program at Methodist Fremont Health can assure breast cancer patients that they are receiving high quality care close to home.

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