1. Quality Assurance Report TTUHSC Breast Center of Excellence January 1, 2013 – December 31, 2013 Compiled by Uzma Nazim, M.D.

2. Stage Distribution Total Number of Patients =74 Time Frame Stage 0Stage IStage IIStage IIIStage IVStage Unassigned Total Jan – Jun 12/37 (32.43%) 12/37 (32.43%) 4/37 (10.81%) 3/37 (8.10%) 5/37 (13.5%) 1/37 (2.7%) 37/37 (100%) Jul - Dec 10/37 (27.02%) 12/37 (32.43%) 9/37 (24.3%) 4/37 (10.8%) 2/37 (5.40%) 0/37 (0%) 37/37 (100%) Jan-Dec 22/74 (29.7%) 24/74 (32.43%) 13/74 (17.5%) 7/74 (9.4%) 7/74 (9.4%) 1/74 (1.3%) 74/74 (100%) Compiled by Uzma Nazim, M.D.

3. Time FrameStage 0Stage IStage IIStage IIIStage IVStage Unassigned Total Jan – Jun Preoperative Core 12/12 (100%) 15/15 (100%) 4/4 (100%) 2/3 (66.7%) 2/2 (100%) 1/1 (100%) 36/37 (97.3%) Jul – Dec Preoperative Core 9/10 (90%) 13/13 (100%) 9/9 (100%) 4/4 (100%) 1/1 (100%) 0/0 (0%) 36/37 (97.3%) Jan-Dec Preoperative Core 21/22 (95.5%) 28/28 (100%) 13/13 (100%) 6/7 (85.7%) 3/3 (100%) 1/1 (100%) 72/74 (97.3%) Mode of Diagnosis Total Number of Patients =74 97.3% of patients had diagnosis established on preoperative core needle biopsy Exceptions2/74 Pts. established diagnosis on excisional biopsy as the primary site is not amenable to image guided biopsy Compiled by Uzma Nazim, M.D.

4. Tumor Board Discussion Total Number of Patients =74 Time Frame Stage 0Stage IStage IIStage IIIStage IVStage Unassigned Total Jan – Jun Discussed 11/12 (91.6%) 11/12 (91.66%) 4/4 (100%) 3/3 (100%) 5/5 (100%) 0/1 (0%) 34/37 (91.9%) Jul – Dec Discussed 9/10 (90%) 12/12 (100%) 9/9 (100%) 4/4 (100%) 2/2 (100%) 0 (0%) 36/37 (97.3%) Jan-Dec Discussed 20/22 (90.9%) 23/24 (95.8%) 13/13 (100%) 7/7 (100%) 7/7 (100%) 0/1 (0%) 70/74 (94.5%) 94.5% of patients were discussed in the multidisciplinary tumor conference Compiled by Uzma Nazim, M.D.

5. Time Frame Stage 0Stage IStage IIStage IIIStage IVStage Unassigned Total Jan – Jun MDC seen 8/12 (66.6%) 14/15 (93.3%) 4/4 (100%) 3/3 (100%) 0/2 (0%) 0/1 (0%) 29/37 (78.3%) Jul – Dec MDC seen 8/10 (80%) 7/13 (53.8 %) 7/9 (77.7%) 3/4 (75%) 0/1 (0%) 0/0 (00%) 25/37 (67.57%) Jan-Dec MDC seen 16/22 (72.7%) 21/28 (75%) 11/13 (84.6%) 6/7 (85.7%) 0/3 (0%) 0/1 (0%) 54/74 (72.97%) Multidisciplinary Assessment (Surgical, Medical and Radiation Oncologist) Total Number of Patients = 74 Exceptions: 20/74 Mastectomy 6/20 Patients with DCIS 6/20 Patient deceased 2/20 Patient transferred 2/20 Patients with advanced metastatic disease 4/20 Compiled by Uzma Nazim, M.D.

6. Time FrameStage 0Stage IStage IIStage IIIStage IVStage Unassigned Total Jan – Jun Assigned 12/12 (100%) 15/15 (100%) 4/4 (100%) 3/3 (100%) 2/2 (100%) 0/1 (0%) 36/37 (97.3%) Jul – Dec Assigned 10/10 (100%) 13/13 (100%) 9/9 (100%) 4/4 (100%) 1/1 (100%) 0 (0%) 37/37 (100%) Jan-Dec Assigned 22/22 (100%) 28/28 (100%) 13/13 (100%) 7/7 (100%) 3/3 (100%) 0/1 (0%) 73/74 (98.65%) Nurse Navigation Total Number of Patients = 74 Exceptions 1/74 (1.35%) Patient sought treatment in Mexico Compiled by Uzma Nazim, M.D.

7. Time FrameStage 0Stage IStage IIStage IIIStage IVStage Unassigned Total Jan – Jun Yes 0/12 (0%) 15/15 (100%) 4/4 (100%) 3/3 (100%) 0/2 (0%) 0/1 (0%) 22/37 (59.4%) Jul – Dec Yes 1/10 (10%) 11/13 (84.6%) 8/9 (88.9%) 3/4 (75%) 0/1 (0%) 0 (0%) 23/37 (62.16%) Jan-Dec Yes 1/22 (4.5%) 26/28 (92.8%) 12/13 (92.3%) 6/7 (85.7%) 0/3 (0%) 0/1 (0%) 45/74 (60.8%) CAP Compliance Total Number of Patients = 74 Compiled by Uzma Nazim, M.D. Exceptions 29/74(39%) Margins can not be assessed 9/29 Patient transferred 3/29 Patient deceased during treatment 3/29 Mastectomy 5/29 Surgery not done 3/29 DCIS 6/29

8. Axillary Staging Total Number of Patients = 74 Total Number of Patients with Invasive Cancer = 52 Number node positive patients on needle biopsy9/52(17.30%) Number of pts. with Stage IV disease 3/52(5.76%) Number of patients eligible for SLNB40/74(54.05%) Number of patients with SLNB31/40(77.5%) Exceptions9/40(22.5%) Determined low risk (unlikely to change treatment plan) 7/9(77.7%) Patient transferred 2/9(22.22%) Compiled by Uzma Nazim, M.D.

9. Axillary Dissection Total Number of Patients = 74 Total Number of Patients with Invasive Cancer =52 Number of patients with stage IV3/52(5.76%) Number of patients with node positive disease 18/52(34.61%) Number of patients eligible for ALND18 Number of patients with ALND7/18(38.9%) Exceptions11/18(61.11%) Low risk for non-SLN mets. on MSKCC nomogram 7/11(63.6%) Patient deceased before final surgery1/11(9%) Surgery done at some other facility 1/11(9%) Final surgery not done yet2/11(18.18%) Compiled by Uzma Nazim, M.D.

10. Time Frame Stage 0Stage IStage IIStage IIIStage IVStage Unassigned Total Jan – Jun Yes 9/12 (75%) 15/15 (100%) 4/4 (100%) 1/3 (33.3%) 0/2 (0%) 0/1 (0%) 29/37 (78.4%) Jul – Dec Yes 8/10 (80%) 6/13 (46.1%) 6/9 (66.6%) 2/4 (50%) 0/1 (0%) 0 (0%) 22/37 (59.5%) Jan-Dec Yes 17/22 (77.27%) 21/28 (75%) 10/13 (76.9%) 3/7 (42.8%) 0/3 (0%) 0/1 (0%) 51/74 (69%) Breast Conservation Total Number of Patients = 74 Number of early stage pts. (0, I and II) with breast conservation 48/63(76.1%) Mastectomies done 18/74(24.3%) Compiled by Uzma Nazim, M.D.

11. Post-lumpectomy Radiation Total Number of Patients =74 Number of patients with lumpectomy 51/74 (68.9%) Number of patients eligible for Radiation 51 Number of patients radiated 43/51(86.2%) Number of patients radiated within 12 months 43/43(100%) Exceptions 8/51(15.7%) Patient had mastectomy after initial lumpectomy 2/8(25%) Patient with small DCIS in prior radiation field 1/8(12.5%) Patient deceased during chemotherapy 1/8(12.5%) Patient refused to get radiation 4/8(50%) Compiled by Uzma Nazim, M.D.

12. Post-Mastectomy Radiation Total Number of Patients = 74 Number of patients with mastectomy 18/74 (24.3%) Number eligible for radiation (>T3 or >N2) 5/18(27.7%) Number of patients radiated 2/5(40%) Number of patients radiated within 12 months 2/2 (100%) Exceptions 3/5(60%) Patient refused radiation 1 /3(33.3%) Patient got treatment from other facility 1/3( 33.3%) Patient deceased during chemotherapy 1/3(33.3%) Compiled by Uzma Nazim, M.D.

13. Systemic Chemotherapy - I Total Number of Patients = 74 ER negative patients with cancer12/74 (16.2%) ER negative patients with DCIS 2/12(16.66%) Number eligible for chemotherapy(exclude DCIS)10/12(83.3%) Number treated with chemotherapy 10/10 (100%) Exceptions 0 Number with chemotherapy within 4 months 10/10(100%) Compiled by Uzma Nazim, M.D.

14. Systemic Chemotherapy - II Total Number of Patients = 74 ER positive patients with cancer62/74 (83.73%) Number treated with chemotherapy21/62(33.98%) Number with chemotherapy within 4 months21/21 (100%) Exceptions 0(0%) Compiled by Uzma Nazim, M.D.

15. Systemic Endocrine Therapy Total Number of Patients = 74 Number of ER positive patients 62/74 (83.78%) Number treated with endocrine therapy 48/62 (77.4%) Exceptions 14/62(22.5%) Determined risk > benefit 3/14 (21.4%) Patients with co morbidities 3/14 (21.4%) Patient non compliant 2/14(14.2%) Patient transferred 3/14(21.4%) Patient deceased 3/14(21.4%) Number with endocrine therapy within 1 year 48/48 (100%) Compiled by Uzma Nazim, M.D.

16. Rehabilitation Total Number of Patients =74 Number enrolled in CPRP (PT/OT)44/74 (59.5%) Exceptions30/74 (40.5%) Services were available but structured program is pending definitive establishment, whereby every patient gets a baseline arm girth and shoulder range of motion documented; prospective data is maintained with a pre-designed schedule. Pts. enrolled in CPRP in 2011 24/107 (22.43%) Pts. enrolled in CPRP in 2012 36/74 (49%) Pts. enrolled in CPRP in 2013 44/74(59.5%) Improvement over 2012 10.5% Compiled by Uzma Nazim, M.D.

17. Genetic Counseling Total Number of Patients = 74 Number of patients with family history or < 45 years49/74 (66.2%) Number received genetic counseling20/49(41%) Number tested13/20(65%) Positive 4/13(30%) Negative9/13(70%) Number refused testing 3/20(15%) Patient transferred to Mexico 1/20(5%) No documentation in the chart 3/20(15%) Exceptions 29/49(59%) Compiled by Uzma Nazim, M.D.

18. Reconstruction For Mastectomy Total Number of Patients = 74 Number of patients with mastectomy18/74 (24.32%) Number of patients with reconstruction12/18(66.66%) Exceptions 6/18(33.3%) Pts. Offered but refused 5/6(83.33%) Stage IV patient with palliative mastectomy 1/6(16.66%) Number of patients with reconstruction in 20129/20(45%) Improvement over 2012 21.66% Compiled by Uzma Nazim, M.D.

19. Time Frame Trial / StudyEligible N (%) Participation N (%) Jan – Jun B-SMART44(100%) CCIP21(50%) SPOC66(100%) MULTIPLE STUDIES2222(100%) Total 34/37(91.9%)33/34(97%) Jul - Dec B-SMART73(43%) CCIP00(0%) SPOC1110(91%) MULTIPLE STUDIES1613(81.2%) Total 34/37(91.9%) 26/34(76.4%) GRAND TOTAL68/74(92%)59/68(87%) Trial Participation Total Number of Patients = 74 Patients participated in trials for 2012 53/71(75%)