Measuring the quality of breast cancer care provided by the California BCCTP

June 23, 2010

Study: Assessing the quality of breast cancer care provided to uninsured women by the California Breast and Cervical Cancer Treatment Program (BCCTP)

Study Design: An observational, prospective, cohort study

Study Eligibility: Women aged 18 years or older diagnosed with stage I to III breast cancer between February 2003 and September 2005, who received treatment through the California BCCTP

Enrollment:  658 women treated for breast cancer through the California BCCTP who consented to a phone survey and medical record review

This study assessed whether the care received by uninsured women through the California BCCTP is similar to that observed in a previous study of largely insured women in a hospital-based cancer registry, using quality measures of breast cancer care developed by the American Society of Clinical Oncology (ASCO). Women were interviewed by phone in either English or Spanish about their treatment experience at 6, 18, and 36 months after enrolling in the BCCTP and had their medical records reviewed.

The 29 quality measures evaluated the process of breast cancer care from diagnosis through post-treatment follow-up, and included documenting tumor characteristics in the pathology report, informing patient of treatment options, hormonal therapy if tumor was hormone receptor-positive, and documenting local radiation therapy after breast conserving surgery, among others.

On average, patients treated through the California BCCTP received 93% of recommended care. Thirty-eight percent of the patients received 100% of recommended care. The researchers found that adherence to the quality measures was as good or better for patients treated through the BCCTP as compared to those in the hospital-based registry, except in the domain of post-treatment surveillance. The only quality measure in that domain indicated that only 87% of the BCCTP cohort had had a mammogram in the previous 12 months compared to 94% of the hospital-based registry cohort.

Five of the quality measures addressed the need to provide patients with information about diagnostic and treatment options. Among these, four were among the quality measures with the lowest adherence levels. For example, among women who had a mastectomy, only 64% had a discussion about breast reconstruction and only 64% reported that breast conserving surgery was discussed with them before undergoing a mastectomy as their first surgical procedure.

Researchers also found that while almost all women with stage II to III breast cancer received adjuvant chemotherapy, one in five did not receive a standard, evidence-based chemotherapy regimen and one in four had not started chemotherapy within two months after surgery.

More women enrolled on the BCCTP were found to have stage III breast cancer than those in the hospital-based cancer registry, 23% and 5%, respectively. And although the CDC's Early Detection Program was developed to make early detection equally accessible to the uninsured as to the insured, and the BCCTP has helped to provide access to needed medical care for the uninsured, the researchers highlighted the importance of policies aimed at providing coverage that is not tied to specific diagnoses to overcome barriers to access and reduce health disparities.

Read the Advocate Analysis of this study.

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