An initial benchmark of the quality of the diagnosis and surgical treatment of breast cancer in South Africa
Background. Monitoring quality indicators to improve breast cancer care is well established in high-income countries. This is the first evaluation of diagnostic and surgical quality indicators for initial benchmarking of breast cancer care in South Africa (SA). Objective. To measure the adher...
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| Language: | English |
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South African Medical Association
2025-02-01
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| Series: | South African Medical Journal |
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| Online Access: | https://samajournals.co.za/index.php/samj/article/view/2292 |
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| author | S Nietz H Cubasch I Buccimazza S Čačala B Phakathi M Joffe W C C Chen S Norris P Ruff |
| author_facet | S Nietz H Cubasch I Buccimazza S Čačala B Phakathi M Joffe W C C Chen S Norris P Ruff |
| author_sort | S Nietz |
| collection | DOAJ |
| description |
Background. Monitoring quality indicators to improve breast cancer care is well established in high-income countries. This is the first evaluation of diagnostic and surgical quality indicators for initial benchmarking of breast cancer care in South Africa (SA).
Objective. To measure the adherence rates to quality indicators among women with breast cancer in SA.
Methods. Ten quality indicators were evaluated for 3 545 breast cancer patients across four SA surgical breast units using a shared electronic patient record system. Data quality and adherence rates with differences between units were determined. The effect of HIV status on adherence was assessed by multivariate Poisson regression analyses.
Results. Our electronic patient record reliably measured most quality indicators. Rates of positive margins (5.7%), overall axillary surgery (95.8%) and appropriate treatment sequencing in locally advanced breast cancer patients (98.4%) consistently reached minimum international standards. Rates of multidisciplinary team discussion (72.2%), radiotherapy (66.7%) and sentinel node biopsy (39.6%) showed wide cross-site variance. Histopathology reporting (62.0%), breast-conserving surgery (19.4%) and number of nodes excised with axillary dissection (47.3%) and sentinel node biopsy (82.7%) were consistently below minimum standards. Unit volumes were achieved consistently in Gauteng Province, but only for some years in KwaZulu-Natal Province; surgeon volumes were achieved across all units. HIV status did not affect adherence levels. Most quality indicators were well measurable, but data quality on reoperations and surgeon volumes was poor.
Conclusion. We evaluated local quality indicators for an initial benchmark, and the most emergent gaps in care are the receipt of radiotherapy and underutilisation of sentinel node biopsy.
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| format | Article |
| id | doaj-art-84d639f906a34b3e91857f18c67034de |
| institution | Kabale University |
| issn | 0256-9574 2078-5135 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | South African Medical Journal |
| spelling | doaj-art-84d639f906a34b3e91857f18c67034de2025-02-10T12:25:25ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352025-02-01115110.7196/SAMJ.2025.v115i1.2292An initial benchmark of the quality of the diagnosis and surgical treatment of breast cancer in South AfricaS Nietz0H Cubasch1I Buccimazza2S Čačala3B Phakathi4M Joffe5W C C Chen6S Norris7P Ruff8Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaDepartment of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaDepartment of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South AfricaDepartment of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Division of Surgery, Faculty of Health Sciences, Stellenbosch University, Cape Town, South AfricaDepartment of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Division of Surgery, Faculty of Health Sciences, Stellenbosch University, Cape Town, South AfricaStrengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaStrengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaSAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Human Development and Health, University of Southampton, UKStrengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Division of Medical Oncology, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Background. Monitoring quality indicators to improve breast cancer care is well established in high-income countries. This is the first evaluation of diagnostic and surgical quality indicators for initial benchmarking of breast cancer care in South Africa (SA). Objective. To measure the adherence rates to quality indicators among women with breast cancer in SA. Methods. Ten quality indicators were evaluated for 3 545 breast cancer patients across four SA surgical breast units using a shared electronic patient record system. Data quality and adherence rates with differences between units were determined. The effect of HIV status on adherence was assessed by multivariate Poisson regression analyses. Results. Our electronic patient record reliably measured most quality indicators. Rates of positive margins (5.7%), overall axillary surgery (95.8%) and appropriate treatment sequencing in locally advanced breast cancer patients (98.4%) consistently reached minimum international standards. Rates of multidisciplinary team discussion (72.2%), radiotherapy (66.7%) and sentinel node biopsy (39.6%) showed wide cross-site variance. Histopathology reporting (62.0%), breast-conserving surgery (19.4%) and number of nodes excised with axillary dissection (47.3%) and sentinel node biopsy (82.7%) were consistently below minimum standards. Unit volumes were achieved consistently in Gauteng Province, but only for some years in KwaZulu-Natal Province; surgeon volumes were achieved across all units. HIV status did not affect adherence levels. Most quality indicators were well measurable, but data quality on reoperations and surgeon volumes was poor. Conclusion. We evaluated local quality indicators for an initial benchmark, and the most emergent gaps in care are the receipt of radiotherapy and underutilisation of sentinel node biopsy. https://samajournals.co.za/index.php/samj/article/view/2292breast cancerQuality of Careelectronic medical recordLow- and middle-income countries |
| spellingShingle | S Nietz H Cubasch I Buccimazza S Čačala B Phakathi M Joffe W C C Chen S Norris P Ruff An initial benchmark of the quality of the diagnosis and surgical treatment of breast cancer in South Africa South African Medical Journal breast cancer Quality of Care electronic medical record Low- and middle-income countries |
| title | An initial benchmark of the quality of the diagnosis and surgical treatment of breast cancer in South Africa |
| title_full | An initial benchmark of the quality of the diagnosis and surgical treatment of breast cancer in South Africa |
| title_fullStr | An initial benchmark of the quality of the diagnosis and surgical treatment of breast cancer in South Africa |
| title_full_unstemmed | An initial benchmark of the quality of the diagnosis and surgical treatment of breast cancer in South Africa |
| title_short | An initial benchmark of the quality of the diagnosis and surgical treatment of breast cancer in South Africa |
| title_sort | initial benchmark of the quality of the diagnosis and surgical treatment of breast cancer in south africa |
| topic | breast cancer Quality of Care electronic medical record Low- and middle-income countries |
| url | https://samajournals.co.za/index.php/samj/article/view/2292 |
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