In June 2011, the staff of the NCCN Opportunities for Improvement (OFI) project reviewed Massachusetts General Hospital’s (MGH) concordance with breast cancer quality measures. This review revealed that a small proportion of patients with breast cancer started chemotherapy more than 120 days after diagnosis, which is considered suboptimal care.1-3 Similarly, data from the NCCN Oncology Outcomes Database showed a small proportion of patients with breast cancer who started adjuvant chemotherapy more than 12 weeks from last definitive surgery (Figure 1). As might be expected, failing to reach the target of chemotherapy sooner than 12 weeks from surgery was more commonly seen in patients who underwent initial surgery outside of the MGH Cancer Center but opted to receive chemotherapy at MGH. Although the total number of cases discordant with this quality measure was small, the research team at MGH saw an opportunity for improvement, especially given the anticipated and continued growth of the MGH Breast Oncology Program.
Therefore, the goal of this project was to increase the percentage of concordance at the MGH Cancer Center with the ASCO quality measure that time to treatment should be less than 120 days from diagnosis (measure 3) and to achieve a decrease in the weeks from last definitive surgery to first adjuvant chemotherapy by 2014.1 Deliverables included concordance reporting to breast cancer teams, reporting of nonconcordant cases to individual providers, and incorporating a discussion of cases that violate the 120-day deadline at multidisciplinary tumor boards.