Four studies report on advances and challenges in improving the quality of cancer care
New studies reveal important advances in cancer care quality measurement, physician adherence to quality standards, and end-of-life care, while highlighting the overuse of contralateral prophylactic mastectomy.
Most preventive double mastectomies occur in women who are at very low risk for contralateral breast cancer. An analysis of two new patient surveys found that two-thirds of women with early-stage breast cancer who underwent contralateral prophylactic mastectomy were not at elevated risk for cancer in the contralateral breast. The researchers found that women who opted for preventive double mastectomy had a high degree of worry about recurrence.
A multidisciplinary team approach to end-of-life care communications leads to reduced use of intensive care among patients with advanced cancer. The researchers found that consultation from a multidisciplinary team increased the election of palliative care and decreased use of more intensive care measures (eg, long-term ventilation and ICU support) among patients with advanced cancer who were hospitalized at a comprehensive cancer center over a 4-year period.
The quality evaluation program of the American Society of Clinical Oncology (ASCO) has documented significant improvement in adherence to quality standards. An analysis of self-reported data from 156 oncology practices participating in ASCO's Quality Oncology Practice Initiative (QOPI) showed that – over a 4-year period – adherence to many quality care standards markedly improved, especially those involving new standard practices (eg, genetic testing for tumor mutations, use of new antinausea drugs, etc.).
A real-time electronic performance tracking system improves adherence to quality care standards for breast and colon cancers. This large study found an association between the use of a quality reporting system developed by the American College of Surgeons and improved adherence to certain quality standards at 64 cancer centers over a 4-year period. The electronic performance tracking system evaluated in this study is the first to provide real-time feedback.
“Ensuring that our patients receive the highest quality care possible is a core responsibility of oncology. The studies presented today show us new strategies for measuring and improving our adherence to quality standards,” said Jyoti Patel, MD, ASCO Cancer Communications Committee member. “The findings also provide insight on discussing treatment options for patients with both early-stage and advanced cancers.”These studies were presented at ASCO's inaugural 2012 Quality Care Symposium in San Diego, California, November 30-December 1, 2012.