Boyle Jemma M, van der Meulen Jan, Kuryba Angela, Cowling Thomas E, Booth Christopher, Fearnhead Nicola S, Braun Michael S, Walker Kate, Aggarwal Ajay
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
Eur J Cancer. 2023 Jan;178:191-204. doi: 10.1016/j.ejca.2022.10.017. Epub 2022 Nov 2.
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.
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.
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.
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.
迄今为止，对于各国医疗体系中与全身抗癌治疗（SACT）相关的护理质量，几乎没有进行过系统评估。我们评估了SACT治疗期间医院层面的毒性发生率，以此作为识别护理质量差异的一种方式。
纳入2016年至2019年间在106家英国国民健康服务体系（NHS）医院接受SACT治疗的所有结直肠癌（CRC）患者。使用经过验证的编码框架，从医院管理数据中得出严重急性毒性发生率。在辅助治疗和转移治疗环境中分别评估医院层面毒性发生率的差异。对毒性发生率进行了年龄、性别、合并症、体能状态、肿瘤部位和TNM分期的调整。
8173例患者接受了辅助治疗的SACT，7683例患者接受了转移治疗的SACT。辅助治疗队列中，调整后的严重急性毒性发生率在各医院之间为11%至49%，转移治疗队列中为25%至67%。与辅助治疗队列的全国平均毒性发生率相比，6家医院高于全国平均水平两个标准差（2SD）以上，4家医院低于全国平均水平2SD以上。在转移治疗队列中，6家医院高于全国平均水平2SD以上，7家医院低于全国平均水平2SD以上。总体而言，12家医院（12%）的毒性发生率高于全国平均水平2SD以上，11家医院（10%）低于全国平均水平2SD以上。
尽管进行了风险调整，但在辅助治疗和转移治疗环境中，医院层面的严重急性毒性发生率仍存在很大差异。持续报告这一绩效指标可用于进一步关注毒性发生率的调查，并推动质量改进举措以改善护理。
