Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer (NQF 0387)

eMeasure Name Oncology Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast Cancer eMeasure Id 73EC4A14-B49B-4793-8469-37A4BA1967D9
Version number 1 eMeasure Set Id 5A6D5F80-37B5-45A2-96A4-8B8FFC3229FF
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward American Medical Association - Physician Consortium for Performance Improvement
Endorsed by National Quality Forum
Description Percentage of female patients aged 18 years and older with Stage IC through IIIC, ER or PR positive breast cancer who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12-month reporting period
Copyright
© 2010 American Medical Association, American Society of Clinical Oncology, and National Comprehensive Cancer Network. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
Despite evidence suggesting the role of adjuvant endocrine therapy in lowering the risk of tumor recurrence, many female patients who should be receiving this therapy are not. 

This measure assesses whether patients with a certain stage of breast cancer (IC through IIIC) and ER/PR+ are currently receiving the therapy. 

There are allowable medical, patient, and system reasons to document instances in which a woman with stage IC through IIIC, ER/PR+ may not be a candidate for the therapy.
Clinical Recommendation Statement
Adjuvant therapy for postmenopausal women with hormone receptor–positive breast cancer should include an aromatase inhibitor in order to lower the risk of tumor recurrence. Aromatase inhibitors are appropriate as initial treatment for women with contraindications to tamoxifen. For all other postmenopausal women, treatment options include 5 years of aromatase inhibitors treatment or sequential therapy consisting of tamoxifen (for either 2 to 3 years or 5 years) followed by aromatase inhibitors for 2 to 3, or 5 years (ASCO guidelines include narrative rankings) (ASCO). 

Patients intolerant of aromatase inhibitors should receive tamoxifen. Women with hormone receptor–negative tumors should not receive adjuvant endocrine therapy (ASCO guidelines include narrative rankings) (ASCO). 

Patients with invasive breast cancers that are estrogen or progesterone receptor positive should be considered for adjuvant endocrine therapy regardless of patient age, lymph node status, or whether or not adjuvant chemotherapy is to be administered (Category 2A) (NCCN). 

The most firmly established adjuvant endocrine therapy is tamoxifen for both premenopausal and postmenopausal women. Prospective, randomized trials demonstrate that the optimal duration of tamoxifen appears to be five years. In patients receiving both tamoxifen and chemotherapy, chemotherapy should be given first, followed by sequential tamoxifen. Several studies have evaluated aromatase inhibitors in the treatment of postmenopausal women with early-stage breast cancer (Category 2A) (NCCN).
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
Winer EP, Hudis C, Burstein HJ, et al. American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women with hormone receptor-positive breast cancer: status report 2004. J Clin Oncol. 2005 Jan 20;23(3):619-29. Available at: http://www.asco.org.
Reference
National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Breast Cancer. Version 1, 2007. Available at: http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf.
Definition
Initial Patient Population(s): Patient Age:  Female patients aged 18 years and older at the beginning of the measurement period.
Diagnosis, Active:  Patient has a documented diagnosis of breast cancer.
Encounter:  At least 2 visits with the physician, physician’s assistant, or nurse practitioner during the measurement period.
Definition
Denominator(s): All female patients aged 18 years and older with Stage IC through IIIC, estrogen receptor (ER) or progesterone receptor (PR) positive breast cancer.
Definition
Denominator Exclusion(s): N/A
Definition
Numerator(s): Patients who were prescribed tamoxifen or aromatase inhibitor (AI) within the 12 month reporting period.
Definition
Denominator Exception(s): Documentation of medical reason(s) for not prescribing tamoxifen or aromatase inhibitor (eg, patient’s disease has progressed to metastatic, patient is receiving a gonadotropin-releasing hormone analogue, patient has received oophorectomy, patient is receiving radiation or chemotherapy, patient’s diagnosis date was ≥ 5 years from reporting date).
Documentation of patient reason(s) for not prescribing tamoxifen or aromatase inhibitor (eg, patient refusal).
Documentation of system reason(s) for not prescribing tamoxifen or aromatase inhibitor (eg, patient is currently enrolled in a clinical trial).
Guidance
The denominator for this measure has been limited to patients with a first recorded breast cancer diagnosis within the past 5 years. The numerator captures patients who are prescribed adjuvant tamoxifen or AI, or received adjuvant tamoxifen or AI during the 12 month period. Date of breast cancer diagnosis is defined as date of pathologic diagnosis.
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012