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

  • many studies have relied on data from the 1980s, and the care evaluated does not represent current practice;
  • many studies are difficult to interpret since dissimilar groups of patients are compared (e.g., insufficient controls for important clinical characteristics such as comorbidity);
  • studies are confined to a small group of patients, in one or a few institutions, states, or health plans, making it difficult to generalize to all cancer patients; and
  • studies are often based on data from cancer registries, which may not accurately represent some aspects of care (e.g., certain treatments may be underreported).

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.

References

Acheson MB, Patton RG, Howisey RL, Lane RF, Morgan A. 1997. Histologic correlation of image-guided core biopsy with excisional biopsy of nonpalpable breast lesions. Archives of Surgery 132:815-821.

Aharony L, Strasser S. 1993. Patient satisfaction: What we know about and what we still need to explore. Medical Care Review 50:49-79.

American Cancer Society. 1998. Cancer Facts and Figures1998. Atlanta, GA.

American Cancer Society. 1999. Cancer Facts and Figures1999. Atlanta, GA.

American Joint Committee on Cancer. 1997. American Joint Committee on Cancer, Cancer Staging Manual, 5th edition, ID Fleming, JS Cooper, DE Henson, et al., (eds.) Philadelphia: Lippincott-Raven.


Ballard-Barbash, R, Potosky A, et al. 1996. Factors associated with surgical and radiation therapy for early stage breast cancer in older women. Journal of the National Cancer Institute 88(11): 716-726.



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