As a founding member of NCCN, City of Hope Comprehensive Cancer Center has a long commitment to the creation of and adherence to treatment guidelines. The NCCN Opportunities for Improvement (OFI) project provided the institution with a report card for adherence to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer and the opportunity to determine reasons for nonconcurrence and improve concurrence rates. The OFI team initially planned to use the timing measures to shorten the time from diagnosis to surgery. However, before the project was started, an outpatient surgery center was opened at City of Hope, and time to surgery was drastically reduced.
Therefore, the team chose to focus on improving compliance with the guideline recommendations regarding the use of intravenous bisphosphonates in women with metastatic bone disease. Given the importance of bone-directed therapies in decreasing the incidence of skeletal-related complications in breast cancer, the team felt that unjustified noncompliance with this recommendation was unacceptable.