data elements needed to assess quality of care. The NCDB does not, however, include important aspects of care that take place in outpatient settings. The NCDB has not yet been widely used to assess quality of care but, if enhanced, would have great potential for doing so.
It is difficult to evaluate the quality of breast and prostate cancer care from the available evidence because
National studies of recently diagnosed individuals with cancer are necessary, using information sources with sufficient detail to allow appropriate comparisons. Ways must be found to produce information from these studies quickly, while they are still relevant to contemporaneous conditions.
Although the available evidence has limitations, it is suggestive of quality problems in cancer care. For women with breast cancer, many do not appear to be receiving indicated radiation therapy after breast conserving surgery. Of equal concern, many women with appropriate indications do not appear to be receiving adjuvant chemotherapy. Both treatments are known to improve outcomes. Furthermore, there is evidence of poor quality in essential aspects of the diagnostic process that is likely to compromise outcomes (e.g., inadequate biopsies, poor reporting of pathology studies). Evidence also suggests that a significant number of women with breast cancer and men with prostate cancer are not receiving information about the full range of treatment options available to them.
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