In the April 1999 Institute of Medicine report, Ensuring Quality Cancer Care, the National Cancer Policy Board suggested that many patients with cancer are not receiving the care known to be effective for their disease. The NCPB believed the problem to be significant, but observed there was insufficient evidence to determine the true magnitude.
In response to this report, ASCO President Dr. Joseph Bailes established the ASCO Task Force on Quality of Cancer Care. Task Force members developed plans for a major study to examine the feasibility of a national quality monitoring system for cancer care.
ASCO contracted with health services researchers at Harvard University and RAND to conduct this feasibility study, called the National Initiative on Cancer Care Quality (NICCQ). This retrospective cohort study of patients with breast and colorectal cancer included detailed medical record reviews and patient self-report survey follow-up four years after diagnosis. Explicit quality of care indicators were developed for eight components of care.
Using the American College of Surgeons (ACOS) National Cancer Database as the sampling frame, the research team sampled patients newly diagnosed with breast cancer or colorectal cancer in 1998 from ACOS-approved hospital registries from five cities with large and diverse cancer populations. Patient surveys and comprehensive medical records abstractions were completed for 1765 patients.
Briefly, NICCQ results indicated that the overall quality of care for patients with breast and colorectal cancer is higher than previously reported. On average, patients with breast cancer received 86% of generally recommended care, based on 36 quality care measures. Patients with colorectal cancer received 78% of generally recommended care, based on 25 quality care measures.
The study also identified areas in need of improvement. Findings suggested that follow-up efforts to improve the quality of breast and colorectal cancer care should target the following areas:
- Optimizing chemotherapy dosing
- Managing side effects associated with treatment
- Advising patients about all treatment options, especially when patient choice is a key factor in the decision making process
- Improving documentation of key information regarding patients’ cancer and treatment, specifically stage and details of chemotherapy planning and delivery
- Ensuring that patients at the highest risk of poor outcomes receive recommended care