Appendix1. Panel members
Name
Affiliation/primary practice setting
Job title
Yuxian Bai
The Third Affiliated Hospital of Harbin Medical University, Harbin, internal medicine
Chief physician
Xiangying Xu
The Third Affiliated Hospital of Harbin Medical University, Harbin, department of
Chief physician
radiation oncology
Yanqiao Zhang
The Third Affiliated Hospital of Harbin Medical University, Harbin, internal medicine
Chief physician
Qingyuan Zhang
The Third Affiliated Hospital of Harbin Medical University, Harbin, internal medicine
Chief physician
Xishan Wang
The Second Affiliated Hospital of Harbin Medical University, Harbin, surgical department
Chief physician
Qifan Zhang
The Fourth Affiliated Hospital of Harbin Medical University, Harbin, surgical department
Chief physician
Yu Yang
The Second Affiliated Hospital of Harbin Medical University, Harbin, internal medicine
Associate chief physician
Fenglin Sun
The Third Affiliated Hospital of Harbin Medical University, Harbin, surgical department
Associate chief physician
Da Pang
The Third Affiliated Hospital of Harbin Medical University, Harbin, surgical department
Chief physician
Gongyan Chen
The Third Affiliated Hospital of Harbin Medical University, Harbin, internal medicine
Chief physician
Yuqing Xu
The Second Affiliated Hospital of Harbin Medical University, Harbin, internal medicine
Chief physician
Jun Zhang
Affiliated Rui Jin Hospital of Shanghai Jiao Tong University School of Medicine,
Associate chief physician
Shanghai, surgical department, department of radiation and chemotherapy oncology
Yi Ba
Cancer Hospital of Tianjin Medical University, Tianjin, internal medicine
Chief physician
Xiaodong Zhang
Beijing Cancer Hospital, Beijing, internal medicine
Chief physician
Chunmei Bai
Peking Union Medical College Hospital, Beijing, internal medicine
Chief physician
Jing Huang
Cancer Hospital of Chinese Academy of Medical Science, Beijing, internal medicine
Associate chief physician
Appendix2. Definitions for final developed quality indicators for breast cancer care
Title
Numerator
Denominator inclusion
Denominator exclusion
Proportion of breast cancer patients who
Breast cancer patients who received bilateral
Patients diagnosed with stage I-III
None
received mammography or breast
mammography or breast ultrasound examination breast cancer and were surgically
ultrasound before surgery
before surgery
treated
Proportion of breast cancer patients who
Breast cancer patients who had diagnosis in
Patients with invasive breast cancer
Metastasis breast cancer; not a first
had diagnosis in cytology and/or histology
cytology and/or histology before surgery
who underwent surgery
or only cancer diagnosis; patients
Structure
Availability of multi-disciplinary breast
cancer team
Process
before surgery
refused; other clinical contradictions
Proportion of breast cancer patients
Breast cancer patients who received ER and PR
Breast cancer patients who received
who received ER and PR assessment
status assessment before systemic therapy
systemic therapy
Male patients
before systemic therapy
HER2 assessment before systemic therapy
Patients with invasive breast cancer who
Patients aged 18 or over, with newly
received
diagnosed invasive breast cancer who
HER2
testing
before
systemic
treatment
Proportion of stage I-II breast cancer
None
received systemic therapy
Patients who received breast-conserving surgery Patients with stage I-II breast cancer
Multifocal breast cancer; received neo-adjuvant
patients who underwent breast-conserving
systemic therapy for >=6 weeks;
surgery
previously received radiotherapy
at ipsilateral breast or chest wall;
Patients refused
Proportion of breast cancer patients who
Breast cancer patients who received SLNB
Breast cancer patients with tumor size
Histology or cytology confirmed
received sentinel lymph nodes biopsy
(sentinel lymph nodes biopsy) surgery
less than 3cm and negative clinical
positive axillary lymph nodes;
examination of axillary lymph nodes
allergic to tracer material;
inflammatory breast cancer
Proportion of breast cancer patients who
Breast cancer patients who underwent breast
Breast cancer patients who received
underwent breast surgery and SLNB
surgery and SLNB examination concurrently
both breast surgery and SLNB
None
examination concurrently
examination
Proportion of breast cancer patients who
Breast cancer patients who received axillary
Breast cancer patients who met one of the
received axillary lymph nodes dissection
lymph nodes dissection
following criteria: positive sentinel
None
lymph nodes biopsy; positive clinical
examination of lymph nodes; positive
pathologic diagnosis of lymph nodes
before surgery
Proportion of premenopausal breast
Premenopausal breast cancer patients who were
Premenopausal breast cancer patients
Male patients; metastatic tumor
cancer patients who were administrated
administrated adjuvant chemotherapy
with positive lymph nodes
Proportion of postmenopausal breast
Breast cancer patients who were administrated
Breast cancer patients diagnosed at age
Patients who participated in clinical
cancer patients with high risk who
adjuvant chemotherapy
50-70, with surgery confirmed positive
trial of chemotherapy or received
lymph nodes or >=2cm tumor size
neo-adjuvant chemotherapy
adjuvant chemotherapy
received adjuvant chemotherapy
Proportion of breast cancer patients who
Patients who were administrated at least four
Breast cancer patients who received
Documentation of reasons for not
were administrated at least four cycles of
cycles of adjuvant chemotherapy
adjuvant chemotherapy
administrating planed cycles of
adjuvant chemotherapy
chemotherapy
Proportion of breast cancer patients treated
Breast cancer patients in whom heart function
Breast cancer patients who were treated
None
by trastuzumab in whom heart function was
was monitored every three months
by trastuzumab treatment
Proportion of breast cancer patients who
Breast cancer patients who received
Patients with invasive breast cancer
In-situ tumor; metastatic tumor;
received radiotherapy after
radiotherapy treatment after breast-conserving
who received breast-conserving surgery
none of 1st course therapy
breast-conserving surgery
surgery
monitored every three months
performed at the reporting facility;
died within 12 months of diagnosis
Proportion of breast cancer patient whose
Breast cancer patients whose radiotherapy
Patients with pathological I-III
Documentation of reasons for
radiotherapy treatment was completed
treatment were completed within a seven-week
disease who received breast-conserving
delaying the adjuvant radiotherapy
within a 7-week interval from the initiation
interval from the initiation of radiotherapy
surgery and subsequent radiotherapy
of radiotherapy
Proportion of breast cancer patients who
Patients who received (45-50) Gy irradiation
Patients with invasive breast cancer
Tumor not originating in the breast;
received standard dose of radiotherapy at
dose at the whole breast
who received adjuvant radiotherapy
documentation of reasons for not
after breast-conserving surgery
administrating standard dose
the whole breast after breast-conserving
surgery
Proportion of breast cancer patients who
Breast cancer patients who received adjuvant
Breast cancer patients who have received None
received adjuvant radiotherapy after
radiotherapy after mastectomy
mastectomy and have tumor >=5 cm or
mastectomy
number of positive lymph node >=4 or
a T4 lesion
Proportion of breast cancer patients who
Breast cancer patients who received 50Gy/5
Patients who have positive surgical
received adjuvant radiotherapy at chest
weeks/25 times adjuvant radiotherapy at chest
margin, tumor size>= 5 cm, or at least 4
wall
wall
positive lymph nodes
Proportion of breast cancer patients who
Patients who were administrated tamoxifen or
Breast cancer patients with positive ER
None
Men; stage IV; aged less than 18;
received tamoxifen or aromatase inhibitor
aromatase inhibitor treatment
treatment
or PR, tumor size >=1cm or positive
none of 1st course therapy
axillary lymph nodes, and was not taking performed at reporting facility;
tamoxifen prior to diagnosis
died within 1 year of diagnosis
Proportion of breast cancer patients who
Breast cancer patients who were administrated
Breast cancer patients with clinical
Patients without histopathologic
received neo-adjuvant chemotherapy
neo-adjuvant chemotherapy
T2-T3 stage
diagnosis of breast cancer
Proportion of breast cancer patients with
Patients with pathology report documented
Patients with a definite diagnosis of
None
pathology report stated status of surgical
status of surgical margin
breast cancer who have received
margin
breast-conserving surgery
Proportion of breast cancer patients with
Patients whose pathology report state category
Patients with a new diagnosis of I-III
pathology report stated category of primary
of primary tumor and regional lymph nodes
invasive breast cancer who have received for not including the pT category,
tumor and regional lymph nodes with
with histologic grade
surgical treatment
histologic grade
Proportion of breast cancer patients with
Documentation of medical reasons
the pN category or the histologic
grade
Patients with pathology report stated
Patients with a diagnosis of stage
None
pathology report stated number of examined
number of examined lymph nodes and
I-III breast cancer who underwent
lymph nodes and positive nodes
number of positive nodes
axillary lymph node dissection
Proportion of breast cancer patients with
Patients with hormone receptor status of tumor
Patients with a diagnosis of invasive
hormone receptor status of the tumor stated
stated in pathology report
I-III breast cancer and had breast tumor
in pathology report
Male patients
removed
Proportion of breast cancer patients with
Patients with pathology report documented
Patients with a diagnosis of I-III breast
Patients previously received
tumor size documented in pathology report
size of tumor
cancer and had breast tumor removed
beast surgery or surgical biopsy
in other facilities
Management of symptoms or
treatment toxicity
Proportion of breast cancer patients who
Patients who received potent anti-emetic
Patients who ever received highly
None of the course of adjuvant
were administrated potent anti-emetic
therapy before receiving highly emetogenic
emetogenic chemotherapy
chemotherapy performed in reporting
therapy
chemotherapy
facility
Proportion of postmenopausal breast cancer
Patients who received endometrial biopsy or
Postmenopausal breast cancer patients
patients who were administrated endometrial
pelvic trans vaginal ultrasound
with vaginal bleeding occur after taking
biopsy or pelvic trans vaginal ultrasound
None
tamoxifen
Communication and Cooperation
Proportion of breast cancer patients who
Patients who were recommended for 5-year
Patients with stage I-III breast cancer
were recommended for five-year endocrine
endocrine treatment
who initiated tamoxifen or aromatase
treatment
Male patients
inhibitor treatment and there is no
evidence of disease progression
Proportion of breast cancer patients who
Patients who were discussed at the
Newly diagnosed breast cancer patients
Patients died before the first
were discussed by MDT team
postoperative MDT meeting and a plan for any
who received treatment
postoperative treatment
further treatment and follow up documented in
the case notes
Outcome
Early postoperative complications
Patients who had postoperative complications
Breast cancer patients who underwent
Patients who did not receive breast
reported, including incision bleeding, flap
surgery
surgery in reporting facility;
necrosis, flap effusion, upper limb edema and
Patients discharged immediately
arm swelling during the postoperative hospital
after surgery
stay
Overall five-year survival rate by stage from
Number of breast cancer patients who still
Number of breast cancer patients
date of breast cancer diagnosis
survived after five years by stage
who discharged alive by stage
None