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INTEGRATED CARE PATHWAYS IN LUNG CANCER: A QUALITY IMPROVEMENT PROJECT

Part of: Special Collection - Methods

Published online by Cambridge University Press:  06 February 2018

Gianpiero Fasola ,
Jessica Menis ,
Alessandro Follador ,
Elisa De Carlo ,
Francesca Valent ,
Giuseppe Aresu ,
Alessandro De Pellegrin ,
Francesco Giacomuzzi ,
David Iuri  and
Emilio Lugatti
...Show all authors
Gianpiero Fasola
Affiliation:
Department of Oncology
Jessica Menis
Affiliation:
Department of Oncology
Alessandro Follador
Affiliation:
Department of Oncology
Elisa De Carlo
Affiliation:
Department of Oncologyelisa.decarlo84@gmail.com
Francesca Valent
Affiliation:
Department of Hygiene and Epidemiology
Giuseppe Aresu
Affiliation:
Department of Thoracic Surgery
Alessandro De Pellegrin
Affiliation:
Department of Pathology
Francesco Giacomuzzi
Affiliation:
Department of Nuclear Medicine
David Iuri
Affiliation:
Department of Radiology
Emilio Lugatti
Affiliation:
Department of Pneumology
Giuseppe Parisi
Affiliation:
Department of Radiotherapy
Guglielmo Pacileo
Affiliation:
Centre for Research on Health and Social Care Management (CERGAS)
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Abstract

Background: Non small cell lung cancer (NSCLC) diagnosis and treatment is a highly complex process, requiring managerial skills merged with clinical knowledge and experience. Integrated care pathways (ICPs) might be a good strategy to overview and improve patient's management. The aim of this study was to review the ICPs of NSCLC patients in a University Hospital and to identify areas of quality improvement.

Materials and Methods: The electronic medical records of 169 NSCLC patients visited at the University Hospital were retrospectively reviewed. Quality of care (QoC) has been measured trough fifteen indicators, selected according main international Guidelines and approved by the multi-disciplinary team for thoracic malignancies. Results have been compared with those of a similar retrospective study conducted at the same hospital in 2008.

Results: A total of 146 patients were considered eligible. Eight of fifteen indicators were not in line with the benchmarks. We compared the results obtained in the two separate periods. Moreover, we process some proposal to be discussed with the general management of the hospital, aimed to redesign NSCLC care pathways.

Conclusions: ICPs confirm to be feasible and to be an effective tool in real life. The periodic measurement of QoC indicators is necessary to ensure clinical governance of patients pathways.

Keywords

Lung cancerIntegrated pathwaysIndicatorsQuality of carePatient's management
Type
Methods
Information
International Journal of Technology Assessment in Health Care , Volume 34 , Issue 1 , 2018 , pp. 3 - 9
Copyright
Copyright © Cambridge University Press 2018 

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References

REFERENCES

1. Siegel, R, Naishadham, D, Jemal, A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63:11–30.CrossRefGoogle ScholarPubMed
2. Coory, M, Gkolia, P, Yang, IA, et al. Systematic review of multidisciplinary teams in the management of lung cancer. Lung Cancer. 2008;60:14–21.CrossRefGoogle ScholarPubMed
3. Coory, M, White, VM, Johnson, KS, et al. Systematic review of quality improvement interventions directed at cancer specialists. J Clin Oncol. 2013;31:1583–1591.CrossRefGoogle ScholarPubMed
4. Tanvetyanon, T, Corman, M, Lee, J-H, et al. Quality of care in non-small-cell lung cancer: Findings from 11 oncology practices in Florida. J Oncol Pract. 2011;7:e25–e31.CrossRefGoogle ScholarPubMed
5. Tanvetyanon, T, Lee, J-H, Fulp, WJ, et al. Changes in the care of non-small-cell lung cancer after audit and feedback: The Florida initiative for quality cancer care. J Oncol Pract. 2014;10:e247–e254.CrossRefGoogle ScholarPubMed
6. Campbell, H, Hotchkiss, R, Bradshaw, N, Porteous, M. Integrated care pathways. BMJ. 1998;316:133–137.CrossRefGoogle ScholarPubMed
7. Campbell, SM, Braspenning, J, Hutchinson, A, Marshall, M. Research methods used in developing and applying quality indicators in primary care. Qual Saf Health Care. 2002;11:358–364.CrossRefGoogle ScholarPubMed
8. Campbell, SM, Braspenning, J, Hutchinson, A, Marshall, MN. Research methods used in developing and applying quality indicators in primary care. BMJ. 2003;326:816–819.CrossRefGoogle ScholarPubMed
9. Hermens, RP, Ouwens, MM, Vonk-Okhuijsen, SY, et al. Development of quality indicators for diagnosis and treatment of patients with non-small cell lung cancer: A first step toward implementing a multidisciplinary, evidence-based guideline. Lung Cancer. 2006;54:117–124.CrossRefGoogle ScholarPubMed
10. von Plessen C, Aslaksen A. Improving the quality of palliative care for ambulatory patients with lung cancer. BMJ. 2005;330:1309–1313.CrossRefGoogle ScholarPubMed
11. Neubauer, MA, Hoverman, JR, Kolodziej, M, et al. Cost effectiveness of evidence-based treatment guidelines for the treatment of non-small-cell lung cancer in the community setting. J Oncol Pract. 2010;6:12–18.CrossRefGoogle ScholarPubMed
12. Ouwens, MM, Hermens, RR, Termeer, RA, et al. Quality of integrated care for patients with nonsmall cell lung cancer: Variations and determinants of care. Cancer. 2007;110:1782–1790.CrossRefGoogle ScholarPubMed
13. Lo, DS, Zeldin, RA, Skrastins, R, et al. Time to treat: A system redesign focusing on decreasing the time from suspicion of lung cancer to diagnosis. J Thorac Oncol. 2007;2:1001–1006.CrossRefGoogle Scholar
14. Tanvetyanon, T. Quality-of-care indicators for non-small cell lung cancer. Cancer Control. 2009;16:335–341.CrossRefGoogle ScholarPubMed
15. Ouwens, M, Hermens, R, Hulscher, M, et al. Development of indicators for patient-centred cancer care. Supportive Care Cancer. 2010;18:121–130.CrossRefGoogle ScholarPubMed
16. Fasola, G, Rizzato, S, Merlo, V, et al. Adopting integrated care pathways in non-small-cell lung cancer: From theory to practice. J Thorac Oncol. 2012;7:1283–1290.CrossRefGoogle ScholarPubMed
17. The Lung Cancer Working Party of the British Thoracic Society Standards of Care Committee. Thorax. 1998;53 (Suppl 1):S1–S8.Google Scholar
18. NCCN Guidelines. http://www.nccn.guidelines.asp. (accessed October 1, 2016).Google Scholar
19. Rivera, MP, Mehta, AC, American College of Chest Physicians. Initial diagnosis of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132 (Suppl):131S–148S.CrossRefGoogle ScholarPubMed
20. Ou, S-HI, Zell, JA. Carcinoma NOS is a common histologic diagnosis and is increasing in proportion among non-small cell lung cancer histologies. J Thorac Oncol. 2009;4:1202–1211.CrossRefGoogle ScholarPubMed
21. Sakr, L, Roll, P, Payan, M-J, et al. Cytology-based treatment decision in primary lung cancer: Is it accurate enough? Lung Cancer. 2012;75:293–299.CrossRefGoogle ScholarPubMed
22. Travis, WD, Rekhtman, N. Pathological diagnosis and classification of lung cancer in small biopsies and cytology: Strategic management of tissue for molecular testing. Semin Respir Crit Care Med. 2011;32:22–31.CrossRefGoogle ScholarPubMed
23. Edwards, SL, Roberts, C, McKean, ME, et al. Preoperative histological classification of primary lung cancer: Accuracy of diagnosis and use of the non-small cell category. J Clin Pathol. 2000;53:537–540.CrossRefGoogle ScholarPubMed
24. Murillo, JR, Koeller, J. Chemotherapy given near the end of life by community oncologists for advanced non-small cell lung cancer. Oncologist. 2006;11:1095–1099.CrossRefGoogle ScholarPubMed
25. Emanuel, EJ, Young-Xu, Y, Levinsky, NG, et al. Chemotherapy use among Medicare beneficiaries at the end of life. Ann Intern Med. 2003;138:639–643.CrossRefGoogle ScholarPubMed
26. Aragon-Ching, JB, Cohn, JB, Cohn, A, et al. Chemotherapy at the end of life. Proc Am Soc Clin Oncol. 2003. Abstract no. 3119.Google Scholar
27. Azzoli, CG, Baker, S, Temin, S, et al. American Society of Clinical Oncology Clinical Practice Guideline update on chemotherapy for stage IV non-small-cell lung cancer. J Clin Oncol. 2009;27:6251–6266.CrossRefGoogle Scholar
28. Zietemann, V, Duell, T. Prevalence and effectiveness of first-, second-, and third-line systemic therapy in a cohort of unselected patients with advanced non-small cell lung cancer. Lung Cancer. 2011;73:70–77.CrossRefGoogle Scholar
29. Eccles, BK, Geldart, TR, Laurence, VM, et al. Experience of first- and subsequent-line systemic therapy in the treatment of non-small cell lung cancer. Ther Adv Med Oncol. 2011;3:163–170.CrossRefGoogle ScholarPubMed
30. Näppä, U, Lindqvist, O, Rasmussen, BH, Axelsson, B. Palliative chemotherapy during the last month of life. Ann Oncol. 2011;22:2375–2380.CrossRefGoogle ScholarPubMed
31. Asahina, H, Sekine, I, Horinouchi, H, et al. Retrospective analysis of third-line and fourth-line chemotherapy for advanced non-small-cell lung cancer. Clin Lung Cancer. 2012;13:39–43.CrossRefGoogle ScholarPubMed
32. Slade, MG, Rahman, NM, Stanton, AE, et al. Improving standards in flexible bronchoscopy for lung cancer. Eur Respir J. 2011;37:895–901.CrossRefGoogle ScholarPubMed
33. Dooms, C, Seijo, L, Gasparini, S, et al. Diagnostic bronchoscopy: State of the art. Eur Respir Rev. 2010;19:229–236.CrossRefGoogle ScholarPubMed
34. Alberts, WM, American College of Chest Physicians. Introduction: Diagnosis and management of lung cancer: ACCP evidence-based clinical practice guidelines (2nd Edition). Chest. 2007;132 (Suppl): 20S–22S.CrossRefGoogle ScholarPubMed
35. O'Rourke, N. Concurrent chemoradiotherapy reduces risk of death at two years compared to sequential chemoradiotherapy or radiotherapy alone in patients with stage III non-small cell lung cancer. Cochrane Database Syst Rev. 2010;6:CD002140.Google Scholar
36. Ross, S, Grant, A, Counsell, C, Gillespie, W, Russell, I, Prescott, R. Barriers to participation in randomised controlled trials: A systematic review. J Clin Epidemiol. 1999;52:1143–1156.CrossRefGoogle ScholarPubMed
37. Hillner, BE. Barriers to clinical trial enrollment: Are state mandates the solution? J Natl Cancer Inst. 2004;96:1048–1049.CrossRefGoogle ScholarPubMed
38. Wang-Gillam, A, Williams, K, Novello, S, et al. Time to activate lung cancer clinical trials and patient enrollment: A representative comparison study between two academic centers across the atlantic. J Clin Oncol. 2010;28:3803–3807.CrossRefGoogle ScholarPubMed
39. Probstfield, JL, Frye, RL. Strategies for recruitment and retention of participants in clinical trials. JAMA. 2011;306:1798–1799.CrossRefGoogle ScholarPubMed
40. Neuss, MN, Malin, JL, Chan, S, et al. Measuring the improving quality of outpatient care in medical oncology practices in the United States. J Clin Oncol. 2013;31:1471–1477.CrossRefGoogle ScholarPubMed
41. Numan, RC, Klomp, HM, Li, W, et al. A clinical audit in a multidisciplinary care path for thoracic surgery: An instrument for continuous quality improvement. Lung Cancer. 2012;78:270–275.CrossRefGoogle Scholar
42. Gerlinger, M, Rowan, AJ, Horswell, S, et al. Intratumor heterogeneity and branched evolution revealed by multiregion sequencing. N Engl J Med. 2012;366:883–892.CrossRefGoogle ScholarPubMed
43. Earle, CC, Neville, BA, Landrum, MB, et al. Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol. 2004;22:315–321.CrossRefGoogle ScholarPubMed
44. Greer, JA, Pirl, WF, Jackson, VA, et al. Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non-small-cell lung cancer. J Clin Oncol. 2012;30:394–400.CrossRefGoogle ScholarPubMed
45. Vansteenkiste, J, De Ruysscher D, Eberhardt WEE, et al. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24 (Suppl 6):vi89–vi98.CrossRefGoogle ScholarPubMed
46. Curran, WJ, Paulus, R, Langer, CJ, et al. Sequential vs. concurrent chemoradiation for stage III nonsmall cell lung cancer: Randomized phase III trial RTOG 9410. J Natl Cancer Inst. 2011;103:1452–1460.CrossRefGoogle ScholarPubMed
47. Eason, K, Waterson, P. The implications of e-health system delivery strategies for integrated healthcare: Lessons from England. Int J Med Inf. 2013;82:e96–e106.CrossRefGoogle ScholarPubMed
48. Bartlett, JE. Adopting integrated care pathways in non-small-cell lung cancer. J Thorac Oncol. 2012;7:e42.CrossRefGoogle ScholarPubMed
49. Ellis, PG, Lokai, K. Impact of a decision support tool on quality measures. Am Soc Clin Oncol. 2013. Abstract no. 6643.CrossRefGoogle Scholar
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