Annelotte van Bommel

31 The NABON Breast Cancer Audit increase over the 4 years for invasive breast cancer (14–21%), and 12% relative increase for DCIS (41–46%). Radiotherapy. Eighty-one percent of the patients diagnosed with locally advanced breast cancer who underwent a mastectomy received additional radiotherapy in 2013. Of the patients undergoing breast conserving surgery for DCIS, 84% received radiotherapy. (Neo-)adjuvant systemic therapy. Neo-adjuvant chemotherapy was increasingly administered over the study period (from 8% in 2011 to 14% in 2014, Table 2 ), and there was a significant variation between hospitals (0–48% in 2014). In 2014, 9% of the patients diagnosed with a cT2 tumor received neo-adjuvant chemotherapy (range 0–57%). The proportion of patients who received either adjuvant or neo- adjuvant chemotherapy decreased slightly over the years ( Table 2 ). Multidisciplinary care process. Ten quality indicators provide insight in the multidisciplinary care process logistics, and four of them have a standardized cut- off value ( Table 2 ). Compared to 2011, more patients were discussed in pre- and post-operative MDT meetings: pre-operative this percentage rose from 83% to 98%, postoperative from 91% to 99%. In addition, variation between the hospitals decreased; in 2014, none of the hospitals discussed significantly less patients than the 90% norm in a post-operative MDT meeting ( Figure 3 ). A similar trend was observed for the pre-operative MDT meeting. Transit times. Time between diagnosis and primary treatment improved, more patients were treated within the predefined time frame of 5 weeks. An immediate breast reconstruction negatively affected the proportion of patients being operated within 5 weeks since diagnosis: from 56% to 88%when immediate breast reconstruction was not performed. The proportion of patients operated timely was lower in hospitals with larger patient volumes. However, an improvement over the years was observed for all time intervals. 2