Measuring variation in the quality of systemic anti-cancer therapy delivery across hospitals: A national population-based evaluation. (January 2023)

• Record Type: Journal Article
• Authors: Boyle, Jemma M.; van der Meulen, Jan; Kuryba, Angela; Cowling, Thomas E.; Booth, Christopher; Fearnhead, Nicola S.; Braun, Michael S.; Walker, Kate; Aggarwal, Ajay
• Is Part Of: European journal of cancer. Volume 178(2023)
• Page Start: 191
• Page End: 204
• Publication Date: 2023-01
• Subjects: Systemic anti-cancer therapy -- Variation -- Quality of care -- Toxicity -- Colorectal cancer -- Performance indicator -- Quality improvement; CAPOX Capecitabine and oxaliplatin -- CRC Colorectal cancer -- CTCAE Common Terminology Criteria for Adverse Events -- FOLFOX 5-FU and oxaliplatin -- 5-FU 5-fluorouracil -- HES Hospital Episode Statistics -- ICD-10 International Classification of Diseases, 10th revision -- NBOCA National Bowel Cancer Audit -- NHS National Health Service -- ONS Office for National Statistics -- OPCS-4 Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures, 4th revision -- RCT Randomised controlled trial -- SACT Systemic Anti-Cancer Therapy -- 2SD 2 standard deviations -- 3SD 3 standard deviations -- UK United Kingdom; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2022.10.017
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Aim: To date, there has been little systematic assessment of the quality of care associated with systemic anti-cancer therapy (SACT) delivery across national healthcare systems. We evaluated hospital-level toxicity rates during SACT treatment as a means of identifying variation in care quality. Methods: All colorectal cancer (CRC) patients receiving SACT within 106 English National Health Service (NHS) hospitals between 2016 and 2019 were included. Severe acute toxicity rates were derived from hospital administrative data using a validated coding framework. Variation in hospital-level toxicity rates was assessed separately in the adjuvant and metastatic settings. Toxicity rates were adjusted for age, sex, comorbidity, performance status, tumour site, and TNM staging. Results: Eight thousand one hundred and seventy three patients received SACT in the adjuvant setting, and 7, 683 patients in the metastatic setting. Adjusted severe acute toxicity rates varied between hospitals from 11% to 49% for the adjuvant cohort, and from 25% to 67% for the metastatic cohort. Compared to the national mean toxicity rate in the adjuvant cohort, six hospitals were more than two standard deviations (2SD) above, and four hospitals were more than 2SD below. In the metastatic cohort, six hospitals were more than 2SD above, and seven hospitals were more than 2SD below the national mean toxicity rate. Overall, 12 hospitals (12%) had toxicity rates more than 2SD above the national mean, and 11 (10%) had rates more than 2SD below. Conclusion: There is substantial variation in hospital-level severe acute toxicity rates in both the adjuvant and metastatic settings, despite risk-adjustment. Ongoing reporting of this performance indicator can be used to focus further investigation of toxicity rates and stimulate quality improvement initiatives to improve care. Highlights: Quality of SACT delivery was evaluated in adjuvant and metastatic colorectal cancer patients. Variation in toxicity rates across 106 English NHS hospitals was used to explore this. Adjusted toxicity rates varied from 11% to 49% (adjuvant) and from 25% to 67% (metastatic). Twelve hospitals had toxicity rates >2SD above the national average, and 11 >2SD below. Ongoing reporting of this performance indicator can be used for quality improvement.