Quality indicators in oncology
Authors: Stordeur Sabine , Vrijens France , Vlayen Joan , Beirens Koen , Devriese Stephan , Van Eycken E. 
Published: January 2025

ABBREVIATIONS 4 -- 1 INTRODUCTION 5 -- 2 SELECTION PROCESS OF QUALITY INDICATORS 6 -- 2.1 METHODOLOGY 6 -- 2.1.1 Literature search 6 -- 2.1.2 Addition of guideline-based quality indicators 6 -- 2.1.3 Selection process 6 -- 2.2 RESULTS 7 -- 3 DATA SELECTION 10 -- 3.1 PRIMARY SELECTION 10 -- 3.2 ADDITIONAL SELECTION 12 -- 3.3 EXPLORATION AND CHECK OF BCR DATA 13 -- 3.4 DATA LINKAGE 16 -- 3.4.1 Linking BCR data to IMA data 16 -- 3.4.2 Linking BCR data to MCD data 16 -- 4 DESCRIPTIVE STATISTICS 18 -- 4.1 DEMOGRAPHIC INFORMATION 18 -- 4.2 TUMOUR CHARACTERISTICS 18 -- 4.2.1 Solitary vs. multiple tumours 18 -- 4.2.2 Morphology 19 -- 4.2.3 TNM staging 19 -- 4.2.4 Incidence rates 21 -- 4.3 DIAGNOSIS AND STAGING 22 -- 4.4 TREATMENT 23 -- 4.5 HOSPITALIZATION 26 -- 5 INDICATOR RESULTS 27 -- 5.1 OVERALL MEASURABILITY OF THE SELECTED QUALITY INDICATORS 27 -- 5.2 INDICATOR RESULTS 34 -- 5.2.1 Survival 34 -- 5.2.2 Diagnosis and staging 37 -- 5.2.3 Neoadjuvant treatment 42 -- 5.2.4 Surgery 43 -- 5.2.5 Adjuvant treatment 43 -- 5.2.6 Treatment of metastatic cancer 46 -- 5.2.7 Follow-up 47 -- 5.2.8 Histopathologic examination 48 -- 5.3 RELATIONSHIP BETWEEN HOSPITAL VOLUME, PROCESSES AND OUTCOMES 48 -- 6 DISCUSSION 52 -- 6.1 INDICATOR RESULTS 52 -- 6.1.1 National level 52 -- 6.1.2 Variability of practices between centres 57 -- 6.1.3 Volume outcome relationship 58 -- 6.2 INDICATORS MEASURABILITY AND INTERPRETABILITY 59 -- 6.3 USE OF INDICATORS FOR QUALITY IMPROVEMENT 62 -- 6.4 CONCLUSIONS 63 -- 7 APPENDIX 64 -- 7.1 SEARCH STRATEGY OVID MEDLINE 64 -- 7.2 OVERVIEW OF ALL IDENTIFIED QUALITY INDICATORS 65 -- 7.3 EVALUATION SCORES OF THE LONG LIST OF QUALITY INDICATORS 90 -- 7.4 METHODS: CONSTRUCTION OF AN ALGORITHM TO ATTRIBUTE A PATIENT TO A -- HOSPITAL 99 -- 7.4.1 Introduction 99 -- 7.4.2 Methods 99 -- 7.4.3 Results 102 -- 7.5 METHODS OF ANALYSIS 106 -- 7.5.1 Descriptive statistics by type of outcome 106 -- 7.5.2 Graphical description of the variability per centre (funnel plots) 107 -- 7.5.3 Volume outcome analyses 107 -- 7.6 QUALITY INDICATORS: GENERAL INDICATORS 108 -- 7.6.1 BC1: overall 5-year survival rate by stage 108 -- 7.6.2 BC2: disease specific 5 year survival by stage 112 -- 7.6.3 BC3: disease-free 5-year survival rate by stage 113 -- 7.6.4 BC4: 5-year local recurrence rate after curative surgery, by stage 115 -- 7.6.5 BC5: Proportion of breast cancer women discussed at the multidisciplinary team -- meeting 117 -- 7.6.6 BC6: Proportion of women with breast cancer who participate in clinical trials 120 -- 7.7 QUALITY INDICATORS: DIAGNOSIS AND STAGING 121 -- 7.7.1 BC7: Proportion of women with class 3, 4 or 5 abnormal mammograms having an -- assessment with a specialist within 2 months of mammography 121 -- 7.7.2 BC8: Proportion of women with class 3, 4 or 5 abnormal mammograms who have at -- least one of the following procedures within 2 months after communication of the screening -- result: mammography, ultrasound, fine-needle aspiration, or percutaneous biopsy 122 -- 7.7.3 BC9: Proportion of newly diagnosed cStage I-III breast cancer women who underwent -- two-view mammography or breast sonography within 3 months prior to surgery 123 -- 7.7.4 BC10: Proportion of women who received axillary ultrasonography with fine needle -- aspiration cytology of the axillary lymph nodes before any treatment 127 -- 7.7.5 BC11: Proportion of women in whom human epidermal growth factor receptor 2 -- (HER2) status was assessed before any systemic treatment 129 -- 7.7.6 BC12: Proportion of women in whom a ER and PgR status assessment were performed -- before any systemic treatment 131 -- 7.7.7 BC13: Proportion of breast cancer women with cytological and/or histological -- assessment before surgery 134 -- 7.7.8 BC14: Proportion of sentinel lymph nodes biopsy in cN0 women without -- contraindications 136 -- 7.8 QUALITY INDICATORS: NEO-ADJUVANT TREATMENT 138 -- 7.8.1 BC15: Proportion of operable cT2-T3 women who received neoadjuvant systemic -- therapy 138 -- 7.9 QUALITY INDICATORS: SURGERY. 141 -- 7.9.1 BC16: Proportion of breast cancer women who underwent an ALND after positive -- SNLB > 2 mm 141 -- 7.9.2 BC17: Proportion of women with high-grade and/or palpable and/or large DCIS of the -- breast who had negative margins after surgery, whatever the surgical option (local wide -- excision or mastectomy) 143 -- 7.9.3 BC18: Proportion of cStage I and II women who undergo breast-conserving surgery / -- mastectomy 144 -- 7.9.4 BC19: Proportion of women with breast cancer recurrence after breast conserving -- surgery who are treated by a mastectomy 147 -- 7.10 QUALITY INDICATORS: ADJUVANT TREATMENT 149 -- 7.10.1 BC20: Proportion of women with a breast cancer who are receiving intravenous -- chemotherapy for whom the planned chemotherapy regimen (which includes, at a minimum: -- drug[s] prescribed, dose, and duration) is documented prior to the initiation, and at each -- administration of the treatment regimen 149 -- 7.10.2 BC21: Proportion of women receiving adjuvant systemic therapy after breast surgery -- for invasive breast cancer 151 -- 7.10.3 BC22: Proportion of women with hormone receptor positive invasive breast cancer or -- DCIS who received adjuvant endocrine treatment (Tamoxifen/AI) 155 -- 7.10.4 BC23: Proportion of women with HER2 positive, node positive or high-risk node -- negative breast cancer (tumour size > 1 cm), having a left ventricular ejection fraction of 55% -- who received chemotherapy and Trastuzumab 157 -- 7.10.5 BC24: Proportion of women treated by Trastuzumab in whom cardiac function is -- monitored every 3 months 158 -- 7.10.6 BC25: Proportion of women who received radiotherapy after breast conserving surgery -- 160 -- 7.10.7 BC26: Proportion of women who underwent a mastectomy and having 4 positive -- nodes who received radiotherapy on axilla following ALND 163 -- 7.11 QUALITY INDICATORS: TREATMENT OF METASTATIC CANCER 165 -- 7.11.1 BC27: Proportion of women with HER2 positive metastatic breast cancer who received -- Trastuzumab with/without non-anthracycline based chemotherapy or endocrine therapy as -- first-line treatment 165 -- 7.11.2 BC28: Proportion of metastatic breast cancer women who receive systemic therapy as -- 1st and/or 2nd line treatment 166 -- 7.11.3 BC29: Proportion of women with metastatic breast cancer and lytic bone metastases -- who received biphosphonates 169 -- 7.12 QUALITY INDICATORS: FOLLOW-UP 171 -- 7.12.1 BC30: Proportion of women who benefit from an annual mammography after a history -- of breast cancer 171 -- 7.13 QUALITY INDICATORS: HISTOPATHOLOGICAL EXAMINATION 174 -- 7.13.1 BC31: Proportion of breast cancer resection pathology reports that include the tumour -- size (macro-and microscopically invasive and DCIS), the histologic type of the primary tumour, -- the pT category (primary tumour), the pN category (regional lymph nodes including numbers), -- the LVI and the histologic grade 174 -- 7.13.2 BC32: Proportion of women with invasive breast cancer undergoing ALND and having -- 10 or more lymph nodes removed 175 -- 7.14 ADMINISTRATIVE CODES 177 -- 7.14.1 General indicators 177 -- 7.14.2 Diagnosis and staging 177 -- 7.14.3 Surgery 182 -- 7.14.4 (Neo)adjuvant treatment 186 -- 7.14.5 Follow-up 201 -- 8 REFERENCES 202