Quality Assurance Report TTUHSC Breast Center of Excellence January 1, 2012 – December 31, 2012 Compiled by Uzma Nazim, M.D.

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Quality Assurance Report TTUHSC Breast Center of Excellence January 1, 2012 – December 31, 2012 Compiled by Uzma Nazim, M.D.

Stage Distribution Total Number of Patients = 74 Time Frame Stage 0Stage IStage IIStage IIIStage IVStage Unassigned Total Jan – Jun9/46 (19.6%) 22/46 (47.8%) 9/46 (19.6%) 4/46 (8.7%) 1/46 (2.17%) 1/46 (2.17%) 46/46 (100%) Jul - Dec6/28 (21.4%) 10/28 (36%) 9/28 (32.1%) 0/28 (0%) 0/28 (0%) 3/28 (10.7%) 28/28 (100%) Jan-Dec15/74 (20.2%) 32/74 (43.2%) 18/74 (24.32%) 4/74 (5.40%) 1/74 (1.35%) 4/74 (5.4%) 74/74 (100%) Compiled by Uzma Nazim, M.D.

Time FrameStage 0Stage IStage IIStage IIIStage IVStage Unassigned Total Jan – Jun Preoperative Core 9/9 (100%) 22/22 (100%) 9/9 (100%) 3/4 (75%) 1/1 (100%) 1/1 (100%) 45/46 (97.82%) Jul – Dec Preoperative Core 4/6 (66.6%) 9/10 (90%) 9/9 (100%) 0/0 (0%) 0/0 (0%) 2/3 (66.6%) 24/28 (85.71%) Jan-Dec Preoperative Core 13/15 (86.6%) 31/32 (96.8%) 18/18 (100%) 3/4 (75%) 1/1 (100%) 3/4 (75%) 69/74 (93.24%) Mode of Diagnosis Total Number of Patients = % of patients had diagnosis established on preoperative core needle biopsy Exceptions Pt. with ADH on core biopsy 1/5 Pts. with implants2/5 Pt. with recurrence after 2009 palliative excision done1/5 Pt. unable to lie prone for stereotactic bx.1/5 Compiled by Uzma Nazim, M.D.

Tumor Board Discussion Total Number of Patients =74 Time Frame Stage 0Stage IStage IIStage IIIStage IVStage Unassigned Total Jan – Jun Discussed 8/9 (88.8%) 20/22 (90.9%) 9/9 (100%) 3/4 (75%) 1/1 (100%) 1/1 (100%) 42/46 (91.3%) Jul – Dec Discussed 4/6 (66.6%) 6/9 (66.6%) 7/9 (77.7%) 0 (0%) 1/1 (100%) 3/3 (100%) 21/28 (75%) Jan-Dec Discussed 12/15 (80%) 26/31 (83.8%) 16/18 (89%) 3/4 (75%) 2/2 (100%) 4/4 (100%) 63/74 (85.1%) 85.1% of patients were discussed in the multidisciplinary tumor conference Compiled by Uzma Nazim, M.D.

Time Frame Stage 0Stage IStage IIStage IIIStage IVStage Unassigned Total Jan – Jun MDC seen 8/9 (88.8%) 19/22 (86.3%) 7/9 (77.7%) 4/4 (100%) 1/1 (100%) 0/1 (0%) 39/46 (84.78%) Jul – Dec MDC seen 5/6 (83.3%) 8/10 (80%) 6/9 (66.6%) 0 (0%) 0 (0%) 3/3 (100%) 22/28 (79%) Jan-Dec MDC seen 13/15 (87%) 27/32 (84%) 13/18 (72.22%) 4/4 (100%) 1/1 (100%) 3/4 (75%) 61/74 (82.4%) Multidisciplinary Assessment (Surgical, Medical and Radiation Oncologist) Total Number of Patients = 74 Exceptions: 13/74 (17.56%) Older than 70 yrs. declined radiation appointment in favor of mastectomy 7/13(53.84%) Under 70 yrs. declined radiation appointment in favor of mastectomy 5/13(38.46%) Patient transferred 1/13(7.6%) Compiled by Uzma Nazim, M.D.

Time FrameStage 0Stage IStage IIStage IIIStage IVStage Unassigned Total Jan – Jun Assigned 9/9 (100%) 21/22 (95.4%) 9/9 (100%) 3/4 (75%) 1/1 (100%) 1/1 (100%) 44/46 (95.65%) Jul – Dec Assigned 6/6 (100%) 9/10 (90%) 9/9 (100%) 0 (0%) 0 (0%) 3/3 (100%) 27/28 (96.4%) Jan-Dec Assigned 15/15 (100%) 30/32 (93.7%) 18/18 (100%) 3/4 (75%) 1/1 (100%) 4/4 (100%) 71/74 (95.9%) Nurse Navigation Total Number of Patients = 74 Exceptions 3/74(4.05%) * HCC pts. did not have full navigation by the nurse through treatment ----HCC notified. Compiled by Uzma Nazim, M.D.

Time FrameStage 0Stage IStage IIStage IIIStage IVStage Unassigned Total Jan – Jun Yes 9/9 (100%) 22/22 (100%) 8/9 (88.8%) 4/4 (100%) 0/1 (0%) 0/1 (0%) 43/46 (93.4%) Jul – Dec Yes 6/6 (100%) 10/10 (100%) 9/9 (100%) 0 (0%) 0 (0%) 0/3 (0%) 25/28 (89.3%) Jan-Dec Yes 15//15 (100%) 32/32 (100%) 17/18 (94.4%) 4/4 (100%) 0/1 (0%) 0/4 (0%) 68/74 (92%) CAP Compliance Total Number of Patients = 74 Compiled by Uzma Nazim, M.D. Exceptions 6/74 (8.1%) Final surgery not done 5/6 (83.3%) Patient transferred 1/6 (16.66%)

Axillary Staging Total Number of Patients = 74 Total Number of Patients with Invasive Cancer = 59 Number node positive patients on needle biopsy5/59 (8.47%) Number of pts. with Stage IV disease 1/59(1.69%) Number of patients eligible for SLNB 53/59(89.8%) – Number of patients with SLNB46/53 (86.79%) Exceptions7/53(13.2%) Determined low risk (unlikely to change treatment plan)6/7(85.7%) Patient transferred 1/7(14.28%) Compiled by Uzma Nazim, M.D.

Axillary Dissection Total Number of Patients = 74 Total Number of Patients with Invasive Cancer = 59 Number of patients with stage IV 1/59 (1.69%) Number of patients with node positive disease 20/59(33.8%) Number of patients eligible for ALND 20 Number of patients with ALND 13/20 (65%) Exceptions7/20 (35%) Low risk for non-SLN mets. on MSKCC nomogram6/7 (85.7%) Final surgery not done yet 1/7 (14.28%) Compiled by Uzma Nazim, M.D.

Time Frame Stage 0Stage IStage IIStage IIIStage IVStage Unassigned Total Jan – Jun Yes 6/9 (66.66%) 18/22 (81.8%) 5/9 (56%) 2/4 (50%) 0/1 (0%) 0/1 (0%) 31/46 (67.39%) Jul – Dec Yes 4/6 (66.6%) 8/10 (80%) 5/9 (56%) 0 (0%) 0 (0%) 0/3 (0%) 17/28 (60.71%) Jan-Dec Yes 10/15 (66.6%) 26/32 (81.25%) 10/18 (56%) 2/4 (50%) 0/1 (0%) 0/4 (0%) 48/74 (64.9%) Breast Conservation Total Number of Patients = 74 Number of early stage pts. (0, I and II) with breast conservation 48/65(74%) Mastectomies done 20/74(27%) Compiled by Uzma Nazim, M.D.

Post-lumpectomy Radiation Total Number of Patients =74 Number of patients with lumpectomy 48/74 (64.8%) Number of patients eligible for Radiation 48 – Number of patients radiated 44/48 (91.66%) Exceptions 4/48(8.3%) Co-morbidity and age >70 yrs. 1/4 (25%) Patient had mastectomy after initial lumpectomy 3/4 (75%) Number of patients radiated within 12 months 44/44(100%) Compiled by Uzma Nazim, M.D.

Post-Mastectomy Radiation Total Number of Patients = 74 Number of patients with mastectomy 20/74 (27%) Number eligible for radiation (>T3 or >N2)2/20(10%) Number of patients radiated2/2(100%) Number of patients radiated within 12 months2/2 (100%) Compiled by Uzma Nazim, M.D.

Systemic Chemotherapy - I Total Number of Patients = 74  ER negative patients with cancer13/74 (17.56%) Number eligible for chemotherapy(exclude DCIS)12/13 (92.3%) – Number treated with chemotherapy 9/12 (75%) Exceptions 3/12 (25%) Patient refused 1/3 (33.3%) Severe co-morbidities and age 2/3(66.6%)  Number with chemotherapy within 4 months9/9(100%) Exceptions0 (none) Compiled by Uzma Nazim, M.D.

Systemic Chemotherapy - II Total Number of Patients = 74  ER positive patients with cancer61/74 (82.43%) Number treated with chemotherapy23/61 (37.78%)  Number with chemotherapy within 4 months20/23 (87%) Exceptions3/23(13%) Pt. developed mirizzi’s syndrome1/3(33.3%) Pt. had wound infection1/3(33.3%) Chemo was within 4 months from cancer diagnosis original biopsy showed ADH1/3(33.3%) Compiled by Uzma Nazim, M.D.

Systemic Endocrine Therapy Total Number of Patients = 74  Number of ER positive patients 61/74 (82.43%) Number treated with endocrine therapy 52/61 (85.24%) Exceptions 9/61 (14.75%) Determined risk > benefit 5/9 (55.6%) Patients with co morbidities 3/9 (33.33%) Patient non compliant 1/9 (11.11%)  Number with endocrine therapy within 1 year 52/52 (100%) Compiled by Uzma Nazim, M.D.

Rehabilitation Total Number of Patients =74 Number enrolled in CPRP (PT/OT)36/74 (49%) Exceptions37/74 (50%) 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 /107 (22.43%) Pts. enrolled in CPRP in /74 (49%) Improvement over % Compiled by Uzma Nazim, M.D.

Genetic Counseling Total Number of Patients = 74 Number of patients with family history or < 45 years49/74 (66.2%) Number received genetic counseling19/49(39%) – Number tested14/19(74%) Positive3/14(21.4%) Negative11/14(79%) – Number refused testing 5/19(26.3%) Exceptions 30/49(61.2%) Did not meet NCCN criteria 24/30(80%) No documentation in the chart6/30(20%) Compiled by Uzma Nazim, M.D.

Time Frame Trial / StudyEligible N (%) Participation N (%) Jan – Jun B-SMART33(100%) CCIP20(0%) SPOC1712(70.6%) MULTIPLE STUDIES2219(86.4%) Total 44/46(96%)34/44(77%) Jul - Dec B-SMART32(66.66%) CCIP55(100%) SPOC62(33.3%) MULTIPLE STUDIES1110(90.9%) Total 27/28(96.4%) 19/27(70.3%) TOTAL71/74(95.9%)53/71(75%) Trial Participation Total Number of Patients = 74 Patients participated in trials for /71(75%)