TABLE 1.
Definitions of Optimal Treatment
| Metric | Definition |
|---|---|
| Breast cancer | |
| Metric 1 | Axillary lymph node evaluation (sentinel lymph node biopsy or axillary dissection) for patients with stage 1–3 cancer who underwent any breast surgeries (breast conserving or mastectomy) within 12 mo after diagnosis (National Comprehensive Cancer Network [NCCN] 3.2013, BINV-D) |
| Metric 2a | Receipt of radiation (RT) after breast-conserving surgery for stage 1–3 invasive breast cancer (excluding patients who underwent mastectomy within 6 m after breast-conserving surgery; NQF 0219; NCCN 3.2013) |
| Metric 2b | Receipt of chemotherapy after any breast surgery for stage 1–3 invasive breast cancer, tumor >1 cm, and estrogen receptor-negative, applying only to patients aged <70 years (NQF 0559; NCCN 3.2013, BINV-8) |
| Metric 3 | Mammogram every 12 mo for 5 y after the first breast-conserving surgery (NCCN 3.2013, BINV-16) |
| Colon cancer | |
| Metric 1 | Colectomy with lymphadenectomy for stage 1–3 (resectable cancer; NCCN 3.2013, COL-2) |
| Metric 2a | Adjuvant chemotherapy for Stage 3 colon cancer (NQF, 0385; NCCN 3.2013, COL-4) |
| Metric 2b | Initiation of adjuvant chemotherapy within 3 mo of surgery date (NQF, 0223; for patients aged <80 y) |
| Metric 3 | Colonoscopy within 12 mo after resection for stage I–III cancer (NCCN 3.2013, COL-3 and COL-4) |
| Prostate cancer | |
| Metric 1 | Primary therapies are prostatectomy, EBRT, brachytherapy (alone or combined with EBRT), and active surveillance |
| Metric 1a | Stage 1–2, low grade (SEER grade 1 [well differentiated]): Active surveillance, surgery, EBRT, brachytherapy (NCCN 4.2013, PROS-2) |
| Metric 1b | Stage 1–2, intermediate grade (SEER grade 2 [moderately differentiated]): Surgery, EBRT, EBRT plus brachytherapy, EBRT plus ADT, EBRT with brachytherapy plus ADT (NCCN 4.2013, PROS-3) |
| Metric 1c | Stage 1–2, high grade: Surgery, EBRT plus ADT, EBRT with brachytherapy plus ADT (NCCN 4.2013, PROS-4) |
| Metric 1d | Stage 3, any grade: Surgery, EBRT plus ADT, EBRT with brachytherapy plus ADT (NCCN 4.2013, PROS-4) |
| Metric 2 | Any ADT or primary EBRT for high-grade tumors (SEER grade 3 and 4 [poorly differentiated, or undifferentiated, or anaplastic), during/near RT (NCCN 4.2013, PROS-4) |
| Metric 3 | At least 1 PSA every 12 mo for 5 y after the first primary treatment (surgeries, or EBRT, or brachytherapy) or after the first active surveillance period (from diagnosis to 12 mo) if no treatment (NCCN 4.2013, PROS-5) |
| Lung cancer | |
| Metric 1a | Nonsmall cell lung cancer stage 1–2: Surgery (lobectomy with mediastinal lymph node dissection; NCCN 2.2013, NSCL-3; NCI PDQ) |
| Metric 1b | Nonsmall cell lung cancer stage 3a: Neoadjuvant chemoradiation therapy followed by surgery (lobectomy plus mediastinal lymph node dissection; NCCN 2.2013, NSCL-7) |
| Metric 1c | Small cell lung cancer: No role for surgery; stage 3 other than 3a (such as stages 3b, 3c, 3 NOS, …): no role for surgery (NCCN 1.2014, SCL-A) |
| Metric 2a | No adjuvant therapy role for stage 1 disease (NCI PDQ) |
| Metric 2b | Adjuvant chemotherapy or RT for nonsmall cell lung cancer stage 2 (NCCN 2.2013, NSCL-3) |
| Metric 2c | Adjuvant RT for nonsmall cell lung cancer stage 3a (NCCN 2.2013, NSCL-3) |
| Metric 3 | Surveillance starts from 2 mo after completion of first treatment (treatments include surgeries for patients who undergo surgeries or first chemotherapy or RT for chemoradiation-only patients); the surveillance will be CT scans of the chest every 12 mo for 5 y (NCCN 2.2013, NSCL-13) |
Abbreviations: ADT, androgen-deprivation therapy; BINV, NCCN invasive breast cancer guideline; CT, computed tomography; EBRT, external-beam radiation therapy; NCCN 2.2013, NCCN guidelines, version 2.2013; NCCN 4.2013, NCCN guidelines, version 4.2013; NCI PDQ, National Cancer Institute Physician Data Query; NOS, not otherwise specified; NQF, National Quality Forum; NSCL, NCCN nonsmall cell lung cancer guideline; PROS, NCCN prostate cancer guideline; PSA, prostate-specific antigen; SCL, NCCN small cell lung cancer guideline; SEER, Surveillance, Epidemiology, and End Results Program.