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Breast Cancer Care Quality in South Africa’s Public Health System: An Evaluation Using American Society of Clinical Oncology/National Quality Forum Measures
PURPOSE: The quality of breast cancer care in sub-Saharan Africa contributes to the region’s dismal breast cancer mortality. ASCO has issued quality measures focusing on delivery of adjuvant chemotherapy, radiotherapy, and endocrine therapy. We applied these measures in five South African public hos...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Society of Clinical Oncology
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882520/ https://www.ncbi.nlm.nih.gov/pubmed/31770052 http://dx.doi.org/10.1200/JGO.19.00171 |
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author | O’Neil, Daniel S. Chen, Wenlong Carl Ayeni, Oluwatosin Nietz, Sarah Buccimazza, Ines Singh, Urishka Čačala, Sharon Stopforth, Laura Joffe, Maureen Crew, Katherine D. Jacobson, Judith S. Neugut, Alfred I. Ruff, Paul Cubasch, Herbert |
author_facet | O’Neil, Daniel S. Chen, Wenlong Carl Ayeni, Oluwatosin Nietz, Sarah Buccimazza, Ines Singh, Urishka Čačala, Sharon Stopforth, Laura Joffe, Maureen Crew, Katherine D. Jacobson, Judith S. Neugut, Alfred I. Ruff, Paul Cubasch, Herbert |
author_sort | O’Neil, Daniel S. |
collection | PubMed |
description | PURPOSE: The quality of breast cancer care in sub-Saharan Africa contributes to the region’s dismal breast cancer mortality. ASCO has issued quality measures focusing on delivery of adjuvant chemotherapy, radiotherapy, and endocrine therapy. We applied these measures in five South African public hospitals and analyzed factors associated with care concordance. MATERIALS AND METHODS: Among 1,736 women with breast cancer who were enrolled in the South African Breast Cancer and HIV Outcomes study over 24 months, we evaluated care using ASCO’s three measures. We also evaluated adjuvant chemotherapy receipt in 957 women with an indication. We used logistic regression to estimate associations between measure-concordant care and patient factors. RESULTS: Of 235 women with hormone receptor–negative cancer, 173 (74%) began adjuvant chemotherapy within 120 days from diagnosis. Of 194 patients who received breast-conserving surgery, 73 (37%) began radiotherapy within 365 days from diagnosis. Of 999 women with hormone receptor–positive cancer, 719 (72%) initiated endocrine therapy within 365 days from diagnosis. Chemotherapy and radiotherapy measure-concordant care were more common among women residing < 20 km from the hospital (odds ratio [OR], 1.79; 95% CI, 1.32 to 2.44 and OR, 3.17; 95% CI, 1.57 to 6.42). Endocrine therapy measure-concordant care was more common among English-speaking women (OR, 2.12; 95% CI, 1.12 to 4.02). Participating hospitals varied in care concordance. HIV infection did not affect care quality. CONCLUSION: More timely delivery of chemotherapy, radiotherapy, and endocrine therapy is needed in South Africa, particularly for women living > 20 km from the hospital or not speaking English. Focused quality improvement efforts could support that goal. |
format | Online Article Text |
id | pubmed-6882520 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | American Society of Clinical Oncology |
record_format | MEDLINE/PubMed |
spelling | pubmed-68825202019-11-29 Breast Cancer Care Quality in South Africa’s Public Health System: An Evaluation Using American Society of Clinical Oncology/National Quality Forum Measures O’Neil, Daniel S. Chen, Wenlong Carl Ayeni, Oluwatosin Nietz, Sarah Buccimazza, Ines Singh, Urishka Čačala, Sharon Stopforth, Laura Joffe, Maureen Crew, Katherine D. Jacobson, Judith S. Neugut, Alfred I. Ruff, Paul Cubasch, Herbert J Glob Oncol Original Reports PURPOSE: The quality of breast cancer care in sub-Saharan Africa contributes to the region’s dismal breast cancer mortality. ASCO has issued quality measures focusing on delivery of adjuvant chemotherapy, radiotherapy, and endocrine therapy. We applied these measures in five South African public hospitals and analyzed factors associated with care concordance. MATERIALS AND METHODS: Among 1,736 women with breast cancer who were enrolled in the South African Breast Cancer and HIV Outcomes study over 24 months, we evaluated care using ASCO’s three measures. We also evaluated adjuvant chemotherapy receipt in 957 women with an indication. We used logistic regression to estimate associations between measure-concordant care and patient factors. RESULTS: Of 235 women with hormone receptor–negative cancer, 173 (74%) began adjuvant chemotherapy within 120 days from diagnosis. Of 194 patients who received breast-conserving surgery, 73 (37%) began radiotherapy within 365 days from diagnosis. Of 999 women with hormone receptor–positive cancer, 719 (72%) initiated endocrine therapy within 365 days from diagnosis. Chemotherapy and radiotherapy measure-concordant care were more common among women residing < 20 km from the hospital (odds ratio [OR], 1.79; 95% CI, 1.32 to 2.44 and OR, 3.17; 95% CI, 1.57 to 6.42). Endocrine therapy measure-concordant care was more common among English-speaking women (OR, 2.12; 95% CI, 1.12 to 4.02). Participating hospitals varied in care concordance. HIV infection did not affect care quality. CONCLUSION: More timely delivery of chemotherapy, radiotherapy, and endocrine therapy is needed in South Africa, particularly for women living > 20 km from the hospital or not speaking English. Focused quality improvement efforts could support that goal. American Society of Clinical Oncology 2019-11-26 /pmc/articles/PMC6882520/ /pubmed/31770052 http://dx.doi.org/10.1200/JGO.19.00171 Text en © 2019 by American Society of Clinical Oncology https://creativecommons.org/licenses/by-nc-nd/4.0/ Creative Commons Attribution Non-Commercial No Derivatives 4.0 License: https://creativecommons.org/licenses/by-nc-nd/4.0/ |
spellingShingle | Original Reports O’Neil, Daniel S. Chen, Wenlong Carl Ayeni, Oluwatosin Nietz, Sarah Buccimazza, Ines Singh, Urishka Čačala, Sharon Stopforth, Laura Joffe, Maureen Crew, Katherine D. Jacobson, Judith S. Neugut, Alfred I. Ruff, Paul Cubasch, Herbert Breast Cancer Care Quality in South Africa’s Public Health System: An Evaluation Using American Society of Clinical Oncology/National Quality Forum Measures |
title | Breast Cancer Care Quality in South Africa’s Public Health System: An Evaluation Using American Society of Clinical Oncology/National Quality Forum Measures |
title_full | Breast Cancer Care Quality in South Africa’s Public Health System: An Evaluation Using American Society of Clinical Oncology/National Quality Forum Measures |
title_fullStr | Breast Cancer Care Quality in South Africa’s Public Health System: An Evaluation Using American Society of Clinical Oncology/National Quality Forum Measures |
title_full_unstemmed | Breast Cancer Care Quality in South Africa’s Public Health System: An Evaluation Using American Society of Clinical Oncology/National Quality Forum Measures |
title_short | Breast Cancer Care Quality in South Africa’s Public Health System: An Evaluation Using American Society of Clinical Oncology/National Quality Forum Measures |
title_sort | breast cancer care quality in south africa’s public health system: an evaluation using american society of clinical oncology/national quality forum measures |
topic | Original Reports |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882520/ https://www.ncbi.nlm.nih.gov/pubmed/31770052 http://dx.doi.org/10.1200/JGO.19.00171 |
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