Measuring outcomes is a five step process:
- Identify outcomes and develop performance measures.
- Create and implement a data collection plan: valid and reliable data is the backbone of programme analysis.
- Analyse the data.
- Communicate the results.
- Reflect, learn, and do it again.
These principals have been rigorously applied in the outcome measurement at The Strathfield Breast Centre.
Data is a Powerful Research Tool
2015 marks the 26th year of operation for The Strathfield Breast Centre(TSBC). Since the doors opened and that first patient with breast cancer trusted their care to us, we have maintained a database collecting accurate patient demographic information, data on work-up, management, histopathology, and outcome. Patient consent to collect and use this data is routinely sought at the first visit.
Each year approximately 330 patients with a new diagnosis of breast cancer are seen by the surgeons at TSBC. (See Figure 1) There are currently in excess of 7000 cases documented in our database.
All information stored in The Strathfield Breast Centre’s breast cancer database is confidential, and there are strict procedures are in place to protect patients’ privacy. For example, access to the source material maintained in our surgeon’s offices is restricted. All research studies involving use of this data must be approved by the relevant surgeons and/or a local appropriately constituted ethics committee.
The database is not intended to be “all things to all people” but rather to be a tool to identify particular groups for further study, such as patients with triple negative cancer, or patients whose management included radiation therapy following mastectomy. It also tells us important information about our patient population. (Figures 2 and 3)
Figure 1: Annual number of new patients
Figure 2: Age distribution
Figure 3: Number of operations (to completely remove the tumor)
Mastectomy was the definitive in procedure 3050 (44%) patients because:
- Patient choice
- Size of tumour in relationship to size of breast
- Type of cancer
Conservation was achieved in 3891 (56%) patient
The Power of Numbers
Clinical data management is a critical phase in clinical research, which leads to generation of high-quality, reliable, and statistically sound data. We have successfully strived to ensure our data is of an excellent standard allowing us to continually evaluate what we do, how we do it and ensure our results are equal to, or better than those of our national and international counterparts.
Our data allows us to look at our outcomes in terms of survival. There are two types of survival measurements:
- Overall Survival: The length of time a patient survives from the time of diagnosis or treatment to death, irrespective of the cause of death
- Disease Free Survival: Length of time after treatment that a patient is alive and well (without a recurrence of the cancer).
We can therefore chart survival incorporating a range of prognostic variables such as stage, the presence of absence of lymph node involvement, the grade, the size and many other variables either alone or in combination with other variables. Here are a few examples:
Survival by Size of Tumor and Extent of Nodal Involvement
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