Quality and Improvement
Through the science of improvement, we aim to improve the quality of breast cancer care by identifying and analyzing problems, intervening, and measuring the effects of interventions. Our quality improvement mission is to standardize best practices to reduce variation, increase reliability, and improve outcomes for patients and healthcare systems.
Journal: Annals of Surgical Oncology
Improving patient safety and quality are priorities in health care. The study of malpractice cases provides an opportunity to identify areas for quality improvement. While the issues surrounding malpractice cases in breast cancer are often multifactorial, there are few studies providing insight into malpractice cases specifically related to common breast cancer surgical procedures. We sought to characterize the factors in liability cases involving breast cancer surgery.
Journal: Annals of Surgical Oncology
Prior work has shown that burnout among breast surgeons is prevalent and highest in those earlier in their clinical practice career. Therefore, we sought to better understand and identify specific contributors to early-career breast surgeon burnout.
Journal: Breast
Reflector-guided localization uses nonradioactive radar implant for wire-free presurgical breast lesion localization. A single-institution retrospective evaluation found lower rates of positive margins and of close margins for reflector-guided localizations compared with wire localizations, resulting in a statistically significant decrease in the re-excision rates (p = 0.015). The two approaches did not show statistically significant difference in localization time and OR time. Technical challenges included particulars inherent in reflector placement, while patient factors included special considerations for reflector placement in the postsurgical breast. Despite novel challenges, we found reflector-guided localization to be accurate and efficient.
Journal: Breast
In summary, the current evidence demonstrates that surgical delay is associated with lower overall survival rates for patients with breast cancer undergoing primary resection without neoadjuvant therapy. The length of delay impacting outcomes varies; however, numerous studies demonstrated a clear and convincing relationship between surgical delay and worse survival. In the neoadjuvant setting, the published research suggests no impact of delay to surgery.
Journal: The Breast Journal
The National Accreditation Program for Breast Centers (NAPBCs) is dedicated to improving the quality of care in patients with breast disease. Geographic distribution of health care resources is an important measure of quality, yet little is known regarding breast center allocation patterns concerning population demand and impact on health outcomes. The purpose of this study was to analyze the distribution of NAPBC programs in the United States (USA) and evaluate the impact on breast cancer survival.
Journal: Breast
Ductal carcinoma in situ (DCIS) is a non-obligate precursor of invasive breast cancer. Current clinical trials are exploring active surveillance (AS) of DCIS. The purpose of this study is to characterize current practice trends in the use of AS. The findings may inform clinical trials and provide insight into factors influencing adoption into practice. The National Cancer Database was used to identify women diagnosed with DCIS from 2004 to 2015. Management with AS was defined as any patient not undergoing surgery, chemotherapy, or radiation therapy.
Journal: Breast
Adjuvant hormonal therapy (HT) is important for the management of hormone-sensitive breast cancer. However, the timeliness for adjuvant HT and the consequences of delayed initiation of treatment have not been analyzed. The purpose of this study was to characterize delays to HT and assess the impact on clinical outcomes. The study cohort consisted of female patients with invasive ductal and/or lobular, hormone receptor-positive breast cancer diagnosed between 2010 and 2015.
Journal: Annals of Surgical Oncology
Physician burnout is a well-recognized problem in health care that has a negative impact on professional well-being and quality of patient care. Rates of burnout in breast surgery are not well-defined. This study sought to understand the degree of burnout among breast surgeons and to identify factors that influence professional fulfillment.
Journal: The American Journal of Surgery
Understanding the underlying factors associated with unplanned readmissions is an important first step toward interventions designed to improve quality of care. This study aimed to identify predictors of unplanned 30-day readmission using a national breast surgery cohort.
Journal: Breast
Introduction: Despite initial increased rates of breast-conserving therapy compared to mastectomy after 1990, mastectomy rates have increased in women under age 40 since 2000. Our study explores the demographic and survival implications of this trend.
Journal: Annals of Surgical Oncology
The Oncotype DX® assay has been validated in predicting response to adjuvant chemotherapy in breast cancer. Its role in neoadjuvant chemotherapy (NCT) has not been established.
Journal: Journal of Surgical Research
Background: Pathological complete response (pCR) after neoadjuvant chemotherapy (NCT) breast cancer is associated with improved survival and facilitates conservative surgical strategies. Invasive lobular carcinoma (ILC) has been observed to have decreased response to NCT compared with invasive ductal carcinoma (IDC). This study seeks to evaluate national trends in the use of NCT for ILC compared with IDC, and determine if there is a subset of ILC patients who demonstrate favorable response rates.
Journal: Annals of Surgical Oncology
Timely administration of adjuvant chemotherapy for breast cancer is associated with a survival benefit. Specific elements of surgical management may lead to delays initiating chemotherapy, resulting in unfavorable outcomes. The purpose of this study was to determine the correlation between surgical factors and delayed chemotherapy in breast cancer patients.
Journal: Annals of Surgical Oncology
Recent trials have suggested the feasibility of performing a sentinel lymph node biopsy (SNB) following neoadjuvant chemotherapy (NAC). The selection of suitable patients for this approach remains controversial. We developed a predictive model to identify patients most likely to benefit from SNB following NAC.
Journal: Breast Disease
Journal: Annals of Surgical Oncology
Patient and tumor factors have been associated with rates for pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) for breast cancer, but variation in pCR rates across facilities has not been studied.
Journal: Annals of Surgical Oncology
Practices regarding recovery after mastectomy vary significantly, including overnight stay versus discharge same day. Expanded use of Enhanced Recovery After Surgery (ERAS) algorithms and the recent COVID pandemic have led to increased number of patients who undergo home recovery after mastectomy (HRAM).
Journal: Annals of Surgical Oncology
The opioid epidemic in the United States is a public health crisis. Breast surgeons are obligated to provide good pain control for their patients after surgery but also must minimize administration of narcotics to prevent a surgical episode of care from becoming a patient's gateway into opioid dependence.
Journal: Cancer
There is a need for guidelines on patient navigation activities to promote both the quality of patient navigation and standards for reimbursement of these services, as lack of reimbursement is a major barrier to implementation, maintenance, and sustainability of these programs.