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BREAST MEASURE SPECIFICATIONS Last Update: 08/06/2019

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BREAST MEASURE SPECIFICATIONS Last Update: 08/06/2019 BREAST MEASURE SPECIFICATIONS Last update: 08/06/2019 Cancer Programs Practice Profile Reports (CP3R) Rapid Quality Reporting System (RQRS) Introduction The Commission on Cancer’s (CoC) National Cancer Data Base (NCDB) staff has undertaken an effort to improve the transparency with which the measures in the CP3R and RQRS reporting systems are calculated. To this end, for each measure, supporting information, three tables and a flow-diagram are provided: • The measure type, clinical rationale and references are provided. • The Measure Item List table provides each cancer registy data item used in the assessment of the indicated measure. This includes the STORE data item name, the North American Association of Central Cancer Registry (NAACCR) item number and a brief description of each item. • The Case Eligibility Criteria table itemizes the steps taken to determine whether cases belong in the measure denominator for cases diagnosed 2010 and later. Each condition is described and is accompanied by the data item and code values used in the assesment. • The Numerator Criteria table illustrates how cases are assessed to determine whether they qualify for the numerator of the measure, in other words are concordant for the standard of care. • A flow-diagram is provided to illustrate the steps through which cases pass as they are evaluted for the indicated measure. The number appearing in each flow-diagram element corresponds to the assessment criteria appearing in the Case Eligibility Criteria and Numerator Criteria tables. Measure Descriptions This document provides specifications for the following measures: Measure Measure Measure Type Abbreviation (NQF #0219) Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70 receiving breast BCSRT Accountability conserving surgery for breast cancer. (NQF #0559) Combination chemotherapy or chemo-immunotherapy (if HER2 positive) is recommended or administered within 4 months MAC Accountability (120 days) of diagnosis for women under 70 with AJCC T1cN0M0 or Stage IB - III hormone receptor negative breast cancer. (NQF #0220) Tamoxifen or third generation aromatase inhibitor is recommended or administered within 1 year (365 days) of diagnosis HT Accountability for women with AJCC T1cN0M0 or Stage IB - III hormone receptor positive breast cancer. Radiation therapy is recommended or administered following any mastectomy within 1 year (365 days) of diagnosis of breast cancer MASTRT Accountability for women with ≥ 4 positive regional lymph nodes. Image or palpation-guided needle biopsy to the primary site is nBx Quality Improvement performed to establish diagnosis of breast cancer. Breast conservation surgery rate for women with AJCC clinical BCS Surveillance stage 0, I, or II breast cancer. 1 Released March 2015 Measure Type There are several types of measures approved by the CoC. Evidence-based measures or accountability measures promote improvements in care delivery and are the highest standard for measurement. These measures demonstrate provider accountability, influence payment for services and promote transparency. The quality improvement measure function is to monitor the need for quality improvement or remediation. Generally, these measures are for individual program use. Surveillance measures are used to identify the status quo, generate information for decision making, and/or to monitor patterns and trends of care. The following Table summarizes the purposes and use of these measures: Measure Type Measure definition and use Accountability High level of evidence supports the measure, including multiple randomized control trials. These measures can be used for such purposes as public reporting, payment incentive programs, and the selection of providers by consumers, health plans, or purchasers. Quality Improvement Evidence from experimental studies, not randomized control trials supports the measure. These are intended for internal monitoring of performance within an organization. Surveillance Limited evidence exist that supports the measure or the measure is used for informative purposes to accredited programs. These measures can be used for to identify the status quo as well as monitor patterns and trends of care in order to guide decision-making and resource allocation. 2 Released March 2015 Last Update 6/30/19 BCSRT – Breast measure: Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer. Measure Type: Accountability NQF # 0219 Clinical Rationale: There is extensive evidence from randomized clinical trials demonstrating the impact of radiation with breast conservation surgery. It reduces the risk of local recurrence in the breast and may have a small impact on survival. The limitation for the purpose of a measure for provider accountability to women under the age of 70 is because of high-level evidence that women with small, estrogen receptor positive cancer (the majority of women over age 70 with breast cancer) gain only a very small reduction in local recurrence and no difference in lifetime mastectomy rate and no difference in survival. The impact as measured by performance gap, improvement in outcome, and numbers of cases affected has been specifically examined by Hasset et al. References: Early Breast Cancer Trialists Collaborative Group (EBCTCG), et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: Meta-analysis of individual patient data for 10,801 women in 17 randomized trials. Lancet. 2011;378 (9804):1707-1716. Hassett MJ, Hughes ME, Niland JC, et al. Selecting high priority quality measures for breast cancer quality improvement. Med Care. 2008;46:762-770. Hughes KS, Schnaper LA, Berry D, et al. Lumpectomy plus Tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. New Engl J Med. 2004;351:971-977. 3 BCSRT - Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer. Measure Item List STORE Data Item NAACCR # Description Sex 220 Sex of patient Age at Diagnosis 230 Age of patient at diagnosis Sequence Number 560 Sequence of malignant and nonmalignant neoplasms over the lifetime Class of Case 610 Indicates the reporting facility’s role in managing the cancer Primary Site 400 Anatomic site of origin of the cancer Date of Initial Diagnosis 390 Date of initial diagnosis of cancer by a physician Histology 522 Microscopic or cellular anatomy of the cancer Behavior Code 523 Neoplastic behavior of the cancer Clinical M 960 Clinical M - AJCC7 Pathologic M 900 Pathologic M - AJCC7 Clinical Stage Group 970 Clinical Stage Group - AJCC7 Pathologic Stage Group 910 Pathologic Stage Group - AJCC7 AJCC TNM Clin M 1003 AJCC Clinical M - AJCC8 AJCC TNM Path M 1013 AJCC Pathologic M - AJCC8 AJCC TNM Clin Stage Group 1004 AJCC Clinical Stage Group - AJCC8 AJCC TNM Path Stage Group 1014 AJCC Pathologic Stage Group - AJCC8 Surgical Procedure of Primary Site 1290 Surgical procedure performed on the primary site of the cancer Dominant modality of radiation therapy administered as first course treatment Regional Treatment Modality 1570 for the cancer, at the reporting facility and all other facilities - NAACCRv16 Radiation modality administered during the first phase of radiation treatment Phase I Radiation Treatment Modality 1506 delivered during the first course of treatment - NAACCRv18 Phase I Radiation Primary Treatment Primary treatment volume or primary anatomic target treated during the first 1504 Volume phase of radiation therapy during the first course of treatment - NAACCRv18 Date Radiation Started 1210 Date of initiation of radiation Date of Last Contact or Death 1750 Date of last contact with the patient, or date of patient death Vital Status 1760 Vital status of the patient, as of the date of last contact or death Exclusion N/A Field used to manually exclude cases (This is a user field, it is not a STORE item) 4 BCSRT - Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer. Case Eligibility Criteria Diagram Assessment STORE Item Code Definitions Reference All dates of diagnosis are included in this 0 Date of Initial Diagnosis Any Dx_Year measure 1 Diagnosis of breast cancer Primary Site C50.0 - C50.9 Exclude: Exclusion 80 - Patient enrolled in a clinical trial 2 Exclude manually censored cases (This is a user field, it is not a STORE item) that directly impacts delivery of the standard of care 3 Female patients only Sex 2 Adult patient under the age of 70 at 4 Age at Diagnosis 018-069 diagnosis First or only diagnosis of malignant 5 Sequence Number 00 or 01 neoplasm For Dx Year 2010-2017 AJCC 7th ed: 8000-8576, 8941-8949 For Dx Year ≥ 2018 AJCC 8th ed: 8000, 8010, 8022, 8032, 8035, 8041, Epithelial tumors which can be staged 8070, 8140, 8200, 8201, 8211, 8246, 6 Histology according to AJCC 8255, 8290, 8314, 8315, 8401, 8410, 8430, 8480, 8500, 8501- 8504, 8507, 8509, 8510, 8513, 8520- 8525, 8530, 8540, 8541, 8543, 8550, 8570, 8571, 8572, 8574, 8575, 8982, 8983 5 BCSRT - Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70 receiving breast conserving surgery for breast cancer. 7 Invasive tumors Behavior Code 3 Pathologic Stage Group AJCC TNM Path Stage For Dx Year ≤2017 AJCC7 Group For Dx Year ≥ 2018 AJCC8 Exclude cases with Pathologic
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