Monitoring Breast Cancer Care Quality at National and Local Level Using the French National Cancer Cohort

The French National Cancer Institute has developed breast cancer Care Quality and Safety Indicators (QIs) based on good clinical practices. The objective is to support quality initiatives, improve pathways and outcomes, and reduce regional inequities. QIs computation is automatable and published annually to all French hospitals. In France, BC care was found to be close to compliance with most QIs. Purpose: The French National Cancer Institute has developed, in partnership with the French National Authority for Health, breast cancer-specific Care Quality, and Safety Indicators (BC QIs). With regard to the most common form of cancer, our aim is to support local and national quality initiatives, to improve BC pathways and outcomes, reduce heterogeneity of practice and regional inequities. In this study, we measure the BC QIs available in the French National medico-administrative cancer database, the French Cancer Cohort, for 2018. Materials and Methods: BC QIs are developed according to the RAND method. QIs are based on good clinical practice and care pathway recommendations. QI computation should be automatable without any additional workload for data collection. They will be published annually for all stakeholders, and especially hospitals. Results: Finally, ten feasible and pertinent QIs were selected. In France, BC care was found to be close to compliance with most QIs: proportion of patients undergoing biopsy prior to first treatment (94.5%), proportion of patients undergoing adjuvant radiotherapy after breast-conserving surgery for BC (94.5%), proportion of women undergoing radiotherapy within 12 weeks after surgery and without chemotherapy (86.2%), proportion of DCIS patients undergoing immediate breast reconstruction (54.3%) and proportion of women with NMIBC undergoing breast reintervention (14.4%). However, some are still far from their recommended rate. In particular, some QIs vary considerably from one region, or one patient, to another. Conclusion: Each result needs to be analyzed locally to find care quality leverage. This will strengthen transparency actions aimed at the public.

Automated summary

The French National Cancer Institute and the French National Authority for Health have developed breast cancer-specific Care Quality and Safety Indicators (BC QIs) to support local and national quality initiatives, improve breast cancer pathways and outcomes, and reduce practice heterogeneity and regional inequities. This study examines the BC QIs available in the French National medico-administrative cancer database for 2018.