Breast Cancer Quality Performance Indicators

Breast cancer is the most common cancer in Aotearoa and predominantly affects women. Each year there are around 3,500 new cases in Aotearoa. In November 2021, Te Aho o Te Kahu established the National Breast Cancer Working Group (NBCWG). Te Aho o Te Kahu and the NBCWG are currently working together to finalise a set of proposed potential QPIs for breast cancer diagnosis and treatment.

A ‘long list’ of breast cancer QPIs were produced by NBCWG and the breast cancer special interest group based on international/national literature and evidence. These were reviewed, and a ‘short list’ of QPIs were developed, based on which would be most valuable to drive quality improvements for breast cancer in Aotearoa.

A final list of 27 potential breast QPIs was identified, with 16 of these QPIs currently able to be measured using Te Rēhita and national collections. These are important for clinical care quality improvement and will be measured and reported on when data is available in the future.

Quality Improvement Monitoring Report

The quality improvement monitoring presents QPIs that are agreed measures of good care, and primarily describes the variation in these measures between districts (previously district health boards (DHBs) prior to 1 July Health and Disability Sector Reforms).

Te Aho o Te Kahu expects districts will review their performance and, where unwarranted variation is identified, take action to improve their performance and patient outcomes. The differences noted in our findings and discussed in this report will also help guide national quality improvement programmes.

We note that some districts are already undertaking quality improvement work. The recommendations in this action plan do not prevent additional actions or the districts continuing to follow existing effective quality improvement activities.

The breast cancer quality improvement monitoring report is currently under development.

Quality Performance Indicator Descriptions

The QPI descriptions report outlines the detailed evidence-based descriptions for each indicator including the numerator and denominator. This report should be read in conjunction with the monitoring report. It includes the 10 indicators that have been measured using Te Rēhita, and those we term ‘aspirational’. Aspirational indicators are important for clinical care quality improvement and may be measured in the future, but the 10 reported on in the monitoring report have been deemed the most important for driving improvements in breast cancer care.

The breast cancer QPI indicator descriptions report is currently under development.

Quality Performance Technical Specifications

The QPI technical specifications report outlines method for calculating each QPI that is reported in the associated monitoring report. This method provides enough detail to recalculate the indicators, if required. It provides information on data sources, numerator criteria, denominator criteria, relevant data codes and descriptions and data flow diagrams.

The breast cancer QPI technical specifications report is currently under development.

National Breast Cancer Working Group

Role

Scoping the breast cancer QPI programme of work was started by the breast cancer significant interest group (SIG) in 2020. In October 2021, following completion of other QPI projects, Te Aho o Te Kahu picked up the work of the SIG and resourced the breast cancer QPI programme of work. Te Aho o Te Kahu established the National Breast Cancer Working Group (NBrWG) in February 2022, after a public call for nominations. In August-September 2022 we consulted on the draft breast cancer QPI descriptions. Following that consultation, the Agency and the NBrWG agreed to use Te Rēhita Mate Ūtaetae - Breast Cancer Foundation National Register (Te Rēhita) as the data source for the breast cancer QPIs. The Agency, the Breast Cancer Foundation National Register and the NBrCWG are currently working together to calculate and report on the 10 breast cancer QPIs that have jointly been agreed are the most important for driving improvements in breast cancer care.

Acknowledgements

Te Aho o Te Kahu Cancer Control Agency, would like to acknowledge Te Rēhita Mate Ūtaetae - Breast Cancer Foundation National Register, for providing the source data and working with the agency to supply technical specifications and calculations for the breast cancer quality performance indicators to help improve equity, the quality of cancer services, and outcomes for people diagnosed with breast cancer across Aotearoa. Te Aho o Te Kahu also thanks Breast Cancer Foundation NZ, as the funder of this register, for supporting this work.

Terms of reference

PDF 259KB - National Breast Cancer Working Group Terms of Reference 

Word 137 KB - National Breast Cancer Working Group Terms of Reference 

Co-Chairs

• Ian Campbell, oncoplastic breast and general surgeon

• Sarah Barton, medical oncologist, Health New Zealand Te Whatu Ora - Capital, Coast and Hutt Valley

Members

• Alex Brown, oncoplastic breast and specialist general surgeon, Health New Zealand Te Whatu Ora – Capital, Coast and Hutt Valley, Bowen Hospital, Wakefield Hospital
• Adele Gautier, research & strategic programmes manager, Breast Cancer Foundation NZ
• Alison Foster, breast physician, Health New Zealand Te Whatu Ora - Capital, Coast and Hutt Valley
• Cheryl MacDonald, clinical nurse specialist breast care, Health New Zealand Te Whatu Ora – MidCentral
• Christine Sapwell, consumer representative, senior nursing lecturer, NorthTec
• Eletha Taylor, oncoplastic breast and general surgeon, Health New Zealand Te Whatu Ora - Te Toka Tumai Auckland
• Fay Sowerby, consumer representative
• Gavin Harris, anatomical pathologist, Canterbury Health Laboratories
• Helen Nott, oncology physiotherapy & lymphoedema therapist, Activate Physiotherapy
• Karen Spells, clinical nurse specialist, Health New Zealand Te Whatu Ora - Te Toka Tumai Auckland
• Madeline Wall, breast radiologist; clinical director, Health New Zealand Te Whatu Ora - Capital, Coast and Hutt Valley
• Marion Kuper, medical oncologist, Health New Zealand Te Whatu Ora – Waikato
• Melissa James, radiation oncologist, Health New Zealand Te Whatu Ora – Waitaha Canterbury
• Melissa Warren, nurse consultant, Breast Cancer Foundation New Zealand
• Natalie James, nurse lead & Support Programme Manager, Breast Cancer Foundation NZ
• Ngaroimata Reid, consumer representative
• Nina Bevin, general practitioner, Westmere Medical Centre, Auckland
• Sheridan Wilson, medical oncologist, Te Pūriri o Te Ora, Auckland Regional Cancer & Blood
• Susan Brooks, radiation oncologist, Health New Zealand Te Whatu Ora - Te Toka Tumai Auckland.