CHAMBER: A Regional Performance Improvement CME Initiative for Breast Cancer Health Care Providers

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CHAMBER was a regional educational initiative for providers of care to patients with HER2+ breast cancer. The study goals were to (1) enhance testing for HER2/neu overexpression in patients with invasive breast cancer; (2) increase the appropriate use of targeted therapy for patients with HER2+ breast cancer; and (3) enhance patients' coping ability. This Performance Improvement Continuing Medical Education (PI-CME) initiative included clinical practice assessment, educational activities, and reassessment. Chart review revealed a high rate of HER2 testing (98%) before and after education. Targeted therapy for patients with HER2+ breast cancer declined after the program (from 96% to 61%), perhaps attributable to an increase in awareness of medical reasons to avoid use of targeted therapy. Assessment for patients' emotional coping ability increased after education (from 55% to 76%; P=.01). Rates of testing for HER2 amplification and assessment of emotional well-being after education were consistent with ASCO Quality Oncology Practice Initiative benchmark values. Documentation of actions to address emotional problems remained an area for improvement.

Correspondence: Daniel U. Rabin, PhD, The France Foundation, 10 Vista Drive, Suite 100, Old Lyme, CT 06371. E-mail: drabin@francefoundation.com
  • 1.

    Cancer Facts & Figures 2012. American Cancer Society Web site. Available at: http://www.cancer.org/research/cancerfactsfigures/cancerfactsfigures/cancer-facts-figures-2012. Accessed July 1, 2014.

    • Search Google Scholar
    • Export Citation
  • 2.

    Slamon DJ, Clark GM, Wong SG. Human breast cancer: correlation of relapse and survival with amplification of the HER-2/neu oncogene. Science 1987;235:177182.

    • Search Google Scholar
    • Export Citation
  • 3.

    Ménard S, Casalini P, Campiglio M. HER2 overexpression in various tumor types, focusing on its relationship to the development of invasive breast cancer. Ann Oncol 2001;12(Suppl 1s):S1519.

    • Search Google Scholar
    • Export Citation
  • 4.

    Stern HM. Improving treatment of HER2-positive cancers: opportunities and challenges. Sci Transl Med 2012.28;4:127rv2.

  • 5.

    Hicks DG, Whitney-Miller CL. The evolving role of HER2 evaluation for diagnosis and clinical decision making for breast and gastric adenocarcinoma. Biotech Histochem 2013;88:121131.

    • Search Google Scholar
    • Export Citation
  • 6.

    Jacobsen PB, Shibata D, Siegel EM. Evaluating the quality of psychosocial care in outpatient medical oncology settings using performance indicators. Psychooncology 2011;20:12211227.

    • Search Google Scholar
    • Export Citation
  • 7.

    Marshall JL, Cartwright TH, Berry CA. Implementation of a performance improvement initiative in colorectal cancer care. J Oncol Pract 2012;8:309314.

    • Search Google Scholar
    • Export Citation
  • 8.

    Quality Oncology Practice Initiative (QOPI®) and the QOPI Certification Program (QCP™). ASCO Institute for Quality Web site. Available at: http://qopi.asco.org. Accessed July 1, 2014.

    • Search Google Scholar
    • Export Citation
  • 9.

    Shershneva MB, Larrison C, Robertson S, Speight M. Evaluation of a collaborative program on smoking cessation: translating outcomes framework into practice. J Contin Educ Health Prof 2011;31(Suppl 1):S2836.

    • Search Google Scholar
    • Export Citation
  • 10.

    Bird GC, Marian K, Bagley B. Effect of a performance improvement CME activity on management of patients with diabetes. J Contin Educ Health Prof 2013;33:155163.

    • Search Google Scholar
    • Export Citation
  • 11.

    Cannon CP, Hoekstra JW, Larson DM. A report of quality improvement in the care of patients with acute coronary syndromes. Crit Pathw Cardiol 2011;10:2934.

    • Search Google Scholar
    • Export Citation
  • 12.

    Kahn N, Bagley B, Tyler S. Performance improvement CME: core of the new CME. CPPD Report 2007;22:16.

  • 13.

    Edge SB, Byrd DR, Compton CC, eds. AJCC Cancer Staging Manual. 7th ed. Chicago, IL: Springer-Verlag; 2010.

  • 14.

    Gradishar WJ, Anderson BO, Balassanian R. NCCN Clinical Practice Guidelines in Oncology for Breast Cancer. Version 2, 2015. Available at: NCCN.org. Accessed July 1, 2015.

    • Search Google Scholar
    • Export Citation
  • 15.

    Practice Guidelines. ASCO Institute for Quality Web site. Available at: http://www.instituteforquality.org/practice-guidelines. Accessed July 1, 2014.

    • Search Google Scholar
    • Export Citation
  • 16.

    Wolff AC, Hammond ME, Schwartz JN. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. Arch Pathol Lab Med 2007;131:1843.

    • Search Google Scholar
    • Export Citation
  • 17.

    Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients'care. Lancet 2003;362:12251230.

  • 18.

    AmerisourceBergen Consulting Services. The Value of Community Oncology: Site of Care Cost Analysis. Available at: www.ourcommunitycounts.org/assets/SiteofCareWhitePaper.pdf. Accessed July 1, 2014.

    • Search Google Scholar
    • Export Citation
  • 19.

    Wolff AC, Hammond ME, Schwartz JNAmerican Society of Clinical Oncology College of American Pathologists. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. J Clin Oncol 2007;25:118145.

    • Search Google Scholar
    • Export Citation
  • 20.

    Phillips KA, Marshall DA, Haas JS. Clinical practice patterns and cost effectiveness of human epidermal growth receptor 2 testing strategies in breast cancer patients. Cancer 2009;115:51665174.

    • Search Google Scholar
    • Export Citation
  • 21.

    Lund MJ, Butler EN, Hair BY. Age/race differences in HER2 testing and in incidence rates for breast cancer triple subtypes: a population-based study and first report. Cancer 2010;116:25492559.

    • Search Google Scholar
    • Export Citation
  • 22.

    Pathmanathan N, Provan PJ, Mahajan H. Characteristics of HER2-positive breast cancer diagnosed following the introduction of universal HER2 testing. Breast 2012;21:724729.

    • Search Google Scholar
    • Export Citation
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