Quality indicators for breast cancer care: A systematic review

KSK is a Distinguished Investigator funded by the Beatriz Galindo (senor modality) Program grant given to the University of Granada by the Ministry of Science, Innovation, and Universities of the Spanish Government. We are thankful for the collaboration of the Europa Donna (The European Breast Cancer Coalition) representatives from Belgium Dr Hirsch and Carly, Dr Aleksandrova from Bulgaria, Dr Moldovanova from Russia, Dr Skjoldborg Hansen from Denmark, Dr Egypt from Estonia, Dr Niemi from Finland, Dr Debiais from France, Dr Sartataviciene from Lithuania, Dr Fischbach from Luxembourg, Dr Barilaro from Monaco, Dr Mellem from Norway, Dr Brankovic-Magica from Serbia, Dr Spanic from Slovenia, Dr Bergsten from Sweden, Dr Corbat from Switzerland, Dr Sprengers from the Netherlands, Dr Spittle from the UK, Dr Maistruck from Ukraine and Europa Donna from Portugal. And we would also like to thank Dr Isabel Rubio (EUSOMA and ESSO President) in Spain, Dr Verhoeven at the Breast Centre Voorkempen in Belgium, Dr Ejlertsen, Dr Bohl and Dr Valvere from the Estonian Cancer Society, Dr Espie from the Hopital Saint-Louis in France, Dr Winkler from the Hungarian League against cancer, Dr Zsuzsanna from the University of Szeged in Hungary, Dr Arnardottir from the Landspitali University Hospital in Iceland, Dr. Dillenbourg from the Universite de Liege in Luxembourg, Dr Daly from the University Hospital Waterford in Ireland, Ms Drochon and Dr Goncharenko from the Institute Nacional du Cancer in France, Dr Jenset from the Swedish Breast Cancer Association, Dr Fredriksson from the Karolinska Institutet in Sweden, Dr Ana Andrijevic from the Institute for pulmonary diseases of Vojvodina, Prof Vrancken Peeters from the Dutch Breast Cancer Audit, Dr Verloop and Dr Siesling from IKNL, Prof Ozmen from the Istanbul Florence Nightingale Hospital, Prof Ozaydin from the Turkish Breast Health Society, Dr Lorez from the Swiss Federal Office of Health, the Swiss Cancer League, Dr Mousavi from the Cancer Registry of eastern Switzerland, and Dr Dagmar from the Swiss Office Q-Label. Finally, we are also grateful for the help provided by the Irish Cancer Society, the Norwegian Breast Cancer Association, the MD Anderson Cancer Center in Spain, the Canadian Breast Cancer Network and the Institute of Breast Disease FUCAM in Mexico, the Ministries of Health from Ireland, Georgia, Iceland, Lithuania and Luxembourg.Breast cancer (BC) management care requires an increment in quality. An initiative to improve the BC quality care is registered, and quality indicators (QIs) are studied. We appraised the appearance of QIs and their standards systematically in Spain. A prospective systematic search (Prospero no: CRD42021228867) for clinical pathways and integrated breast cancer care processes was conducted through databases and the World Wide Web in February 2021. Duplicate data extraction was performed with 98% reviewer agreement. Seventy-four QIs (QI per document mean: 11; standard deviation: 10.59) were found in 15 documents. The Catalonian document had the highest number of QIs (n = 30). No QI appeared in all the documents. There were 9/74 QIs covering structure (12.16%), 53/74 covering process (71.62%), and 12/74 covering outcome (16.22%). A total of 22/66 (33.33%) process and outcome QIs did not set a minimum standard of care. QIs related to primary care, patient satisfaction, and shared decision making were deficient. Most of the documents established a BC QI standard for compliance, but the high variability hinders the comparison of outcomes. Establishing a consensus-based set of QIs needs urgent attention.Spanish Governmen