Dear Editor,
We read with interest a recent study by Pons-Tostivint et al. [1], assessing compliance of breast cancer (BC) care with EUSOMA [2] quality indicators (QIs). As more and more studies evaluating the quality of BC care are using EUSOMA-QIs, we think it is important to clarify inconsistencies in their definitions which might have influenced the results of this study and similar ones [1,[3], [4], [5]].
Firstly, there is a discrepancy in the definition of hormone-positive (HR+) BC. Recent studies considered HR+ BC if immunostaining was seen in ≥1% tumor nuclei [4,5] compared to Pons-Tostivint et al. [1] using a cut-off value of ≥10%, which calls for unified definition of HR+ disease in EUSOMA-QIs to homogenise reporting.
Secondly, a refinement of the definition of QI 13a, which assesses the proportion of patients with ER-negative invasive carcinoma (T >1 cm or N+) who received adjuvant chemotherapy, is needed. The authors reported that the proportion of patients who received adjuvant chemotherapy was lower than the mandatory 85% EUSOMA recommendation [1], but did not clearly stated if patients receiving neoadjuvant chemotherapy were considered as being treated in discordance with QI 13a.
Refining the definitions of EUSOMA-QIs would make the results of such studies easier to compare.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declaration of competing interest
None.
Contributor Information
Ivica Ratosa, Email: iratosa@onko-i.si.
Gaber Plavc, Email: gplavc@onko-i.si.
References
- 1.Pons-Tostivint E., Daubisse-Marliac L., Grosclaude P., Oum sack E., Goddard J., Morel C. Multidisciplinary team meeting and EUSOMA quality indicators in breast cancer care: a French regional multicenter study. Breast. 2019;46:170–177. doi: 10.1016/j.breast.2019.06.001. [DOI] [PubMed] [Google Scholar]
- 2.Biganzoli L., Marotti L., Hart C.D., Cataliotti L., Cutuli B., Kühn T. Quality indicators in breast cancer care: an update from the EUSOMA working group. Eur J Canc. 2017;86:59–81. doi: 10.1016/j.ejca.2017.08.017. [DOI] [PubMed] [Google Scholar]
- 3.Taban F., Elia N., Rapiti E., Rageth C., Fioretta G., Benhamou S. Impact of experience in breast cancer surgery on survival: the role of quality of care in a registry-based cohort. Swiss Med Wkly. 2019;149:w14704. doi: 10.4414/smw.2019.14704. [DOI] [PubMed] [Google Scholar]
- 4.Plavc G., Ratoša I., Žagar T., Zadnik V. Explaining variation in quality of breast cancer care and its impact : a nationwide population-based study from Slovenia. Breast Canc Res Treat. 2019;175(3):585–594. doi: 10.1007/s10549-019-05186-z. [DOI] [PubMed] [Google Scholar]
- 5.Cowppli-Bony A., Tretarre B., Marrer E., Defossez G., Daubisse-Marliac L., Coureau G. Compliance with clinical guidelines for breast cancer management: a population-based study of quality-of-care indicators in France. PloS One. 2019;14:1–16. doi: 10.1371/journal.pone.0224275. [DOI] [PMC free article] [PubMed] [Google Scholar]