Improving Breast Cancer Surgery Quality through a Collaborative Surgery Database

描述（由申请人提供）：该申请涉及广泛的挑战领域（04）临床研究和特定的挑战主题，04- ca -111：癌症手术的质量和结果。该应用程序也与广泛的挑战领域（05）比较有效性研究和特定挑战主题05- ca -104：癌症治疗的比较有效性研究具有特定的相关性。尽管全世界范围内乳腺癌手术的频率很高，但在外科医生或医院层面上仍然缺乏可识别的手术结果的数据。最近针对乳腺癌手术提出了手术质量的衡量标准。该申请旨在将佛蒙特大学在癌症手术结果评估方面的专业知识与癌症研究网络（CRN）的专业知识相结合，CRN是癌症相关有效性研究前沿的研究人员网络。目前还没有可用的医疗管理数据库来进行乳腺癌初始手术的比较效果研究，由于现有数据库缺乏目前驱动初始乳房手术决策的关键数据元素的特异性和细节，我们建议开发一个多中心电子乳腺癌手术结果数据库，通过检查初始乳腺癌手术结果的变化来评估手术质量的措施。此外，我们将开发可在其他地方实施的协议和数据捕获工具，以便将该数据网络扩展到未来的其他CRN站点。这样一个临床数据网络的发展将允许进行比较有效性的研究，特别是与当前乳腺癌管理中的争议相关的研究，例如乳房部分切除术中适当的病理清除范围。我们认为，目前这一争议导致每年进行数万例额外的手术，降低了患者的生活质量，花费了数亿美元，但对癌症复发或患者生存没有明确的影响。我们开发了一个设计良好的癌症手术结果数据库，将允许重要的临床问题得到及时和经济有效的回答。

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (04) Clinical Research and the specific Challenge Topic, 04-CA-111: Quality of Cancer Surgery and Outcomes. This application also has specific relevance to broad challenge area (05) Comparative Effectiveness Research and specific Challenge Topic 05-CA-104: Comparative Effectiveness Research on Cancer Treatment. Despite the frequency of breast cancer surgery worldwide, there remains a paucity of data for surgical outcomes discernable at the surgeon or hospital level. Recent measures of surgical quality have been proposed for breast cancer surgery. This application seeks to combine the expertise of the University of Vermont in cancer surgery outcomes assessment with expertise of the Cancer Research Network (CRN), a network of investigators at the forefront of cancer-related effectiveness research. There is currently no available healthcare administrative database which will allow comparative effectiveness research of initial breast cancer surgery, as existing databases lack the specificity and detail of critical data elements that currently drive decisions for initial breast surgery We propose to develop a multicenter electronic breast cancer surgery outcomes database that will allow for an assessment of measures of surgical quality by examining variation in outcomes of initial breast cancer surgery. In addition, we will develop protocols and data capture tools that can be implemented elsewhere in order to extend this data network to future additional CRN sites. The development of such a clinical data network will allow comparative effectiveness research to be conducted, particularly as related to current controversies in the management of breast cancer, such as an appropriate pathologic margin of clearance in partial mastectomies. We believe this controversy currently results in tens of thousands of additional operations performed annually, lowering patient quality of life and at the cost of hundreds of millions of dollars, without specified impact on cancer recurrence or patient survival. Our development of a well designed cancer surgery outcomes database will allow for important clinical questions to be answered in a timely and cost-effective manner. PUBLIC HEALTH RELEVANCE: This application seeks to firmly establish measures of quality for initial breast cancer surgery. Improved understanding of surgical quality can potentially diminish wide variability in outcomes and healthcare costs associated with breast cancer surgery.