Quality Indicators for the Care of Breast Cancer in Vulnerable Elders

Breast cancer is the most common cancer diagnosed in women and the second highest cause of cancer mortality in the United States Although approximately half of the women diagnosed with breast cancer are older than 65, older patients are frequently underrepresented in oncology clinical trials. Consequently, the risks and benefits of treatments is not well understood in older women. Some studies suggest that elderly patients with breast cancer are undertreated and thus have higher mortality then their younger counterparts. This monograph discusses the relationship between processes and outcomes of care for breast cancer, identifies potential quality indicators (QIs) that may be used to assess the treatment of vulnerable elders (VEs) with breast cancer, and reviews the available evidence in support of these indicators. METHODS: A total of 1,294 articles were considered in this review: 38 were identified using a Web search and 1,256 through Assessing Care of Vulnerable Elders (ACOVE)-3 literature searches. One limitation in developing this QI set was that, for some topics, previous studies and analyses had limited data on older patients. An effort was made to denote data specific to an older population within the text when they were available and relevant. RESULTS: Of the 24 potential QIs, 21 were judged valid using the expert panel process, three were rejected, and two were added, for a total of 23 in the final set. The literature summaries that support each of the indicators judged to be valid in the expert panel process are described.