Breast cancer is the leading solid tumor site disgnosed at Moffitt Cancer Center and accounts for almost 15% of the overall patient population. The 5-year observed survival rate for all stages of breast cancer analyzed at Moffitt Cancer Center is 87.8% compared with 85.4% for all other Commission on Cancer-approved programs.1 The higher survival rate may be attributed to physician adherence to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer2 and high-quality multidisciplinary patient care.
Moffitt Cancer Center participated in the NCCN Oncology Outcomes Database for Breast Cancer, which collected detailed information on various measures related to breast cancer diagnosis and treatment. Feedback with comparison data among sponsored institutions was provided. Analysis of the NCCN TiCToC (Timing in Continuation and Transition of Care) Measures revealed that Moffitt Cancer Center lagged in the time from breast biopsy to first definitive surgery with an average of 6.9 weeks, benchmarked in the bottom third. This fact concerned the faculty of the Breast Program, because delay in time to curative surgery may be associated with increased mortality.3 Further, awaiting breast cancer surgical procedures increases patient anxiety, which impacts quality of life.4 Delays in surgery, especially involving immediate breast reconstruction, also create delays in the initiation of adjuvant systemic therapy and postoperative radiation therapy.5,6
In 2011, NCCN provided generous funding to Moffitt Cancer Center to participate in the Opportunity for Improvement (OFI) project. The goal of this program was to determine institutional areas of breast cancer care in need of improvement. Based on background data analysis, the team at Moffitt Cancer Center sought to obtain detailed information on steps in delay from breast biopsy to definitive surgery and to develop proposals and strategies for improvement.
American College of Surgeons Commission on Cancer. National Cancer Database Survival Statistics. Available at: http://www.facs.org/cancer/ncdb/survival.html. Accessed December 16, 2013.
Theriault RL, Carlson RW, Allred C. NCCN Clinical Practice Guidelines in Oncology for Breast Cancer. Version 3.2013. Available at NCCN.org. Accessed December 13, 2013.
Shin DW, Cho J, Kim SY. Delay to curative surgery greater than 12 weeks is associated with increased mortality in patients with colorectal and breast cancer but not lung or thyroid cancer. Ann Surg Oncol 2013;20:2468–2476.
Drageset S, Lindstrom TC, Giske T, Underlid K. Being in suspense: women’s experiences awaiting breast cancer surgery. J Adv Nurs 2011;67:1941–1951.
Kontos M, Lewis RS, Luchtenborg M. Does immediate breast reconstruction using free flaps lead to delay in the administration of adjuvant chemotherapy for breast cancer? Eur J Surg Oncol 2010;36:745–749.
Goktas SB, Gulluoglu BM, Selimen D. Immediate or delayed breast reconstruction after radical mastectomy in breast cancer patients: does it make a difference in the quality of life? Turkiye Klinik J Med Sci 2011;31:664–673.
Mosunjac M, Park J, Strauss A. Time to treatment for patients receiving BCS in a public and a private university hospital in Atlanta. Breast J 2012;18:163–167.
Blecicher RJ, Ruth K, Sigurdson ER. Preoperative delays in the US Medicare population with breast cancer. J Clin Oncol 2012;30:4485–4449.