Background
As the management of cancer continues to rise in cost and complexity, there must be an attendant focus on its quality and consistency. There is a lack of validated quality indicators (QI) and challenges in collecting the comprehensive data with which to measure them. Clinical cancer registries, such as TRACC (Treatment of recurrent and Advanced Colorectal Cancer) collect data at multiple sites on the diagnosis, clinicopathological characteristics, treatment and outcomes for cancer patients. This data could be harnessed for the purposes of quality measurement.
Methods
We reviewed the literature examining QI for metastatic colorectal cancer (mCRC). We then explored the potential of existing TRACC data items as quality indicators, exploring any variation in practice (biomarker testing, drug therapy or surgery) across major sites. For any observed variation we explored the association with clinical outcomes.
Results
In our literature review we found no well validated QI in the multidisciplinary care of mCRC. Analysis of TRACC found significant variability between sites in key biomarker testing, chemotherapeutic and biologic agent administration, and curative intent surgery. We engaged multiple Victorian sites to participate in a quality-focused pilot trial called BETTER-TRACC (Benchmarking and Tracking Treatment and Response in Advanced Colon Cancer), using funding secured from the Victorian Cancer Agency. A modified Delphi study is in process to define a set of QI that can be extracted from TRACC data. Quality Appraisals then will be circulated to participating sites, with each site receiving summary data on their performance in comparison to other de-identified sites. Subsequent surveys will gauge the impact, strengths and limitations of the Quality Appraisals and inform the further evolution of the project.
Conclusion
Ensuring mCRC patients are accessing equitable, timely, evidenced-based high quality cancer care is an unaddressed need. Leveraging existing TRACC registry data, clinicians will gain insights into the quality of care provided at their institution and opportunities for improvement.