Radiotherapy Quality Indicators in the Pilot Program of the NON in Poland in 2019-2021

Abstract

The pilot program of the National Oncology Network (NON) is the 1st Polish joint action concerning the construction of an oncological network, including the construction of a quality monitoring system. Data collection was started prospectively after obtaining consent from the Patient since February 2019 in 2 voivodeships: Lower Silesia and Holy Cross, and since October 2019 also in Podlaskie and Pomeranian. The aim of the pilot program was to assess the organization and quality of oncological care in selected voivodeships in 5 types of cancer - prostate, ovarian, colorectal, breast and lung cancer. For the needs of the pilot program, an IT quality monitoring system was built, including: medical data warehouse, data reporting program and data visualization tool. The quality indicators (QI) were calculated in the Lower Silesia and those related to RT were further analyzed: F_4 - % of deaths within 30 days from the end of palliative RT, according to cancer stage; F_6 - % of patients (pts) requiring hospitalization due to side effects after RT; F_16 - % of pts with rectal cancer who received preoperative RT and F_25 - % of pts with stage III NSCLC who received concurrent CRT. The data was prepared both cumulatively for the whole time framework and year-to-year. In both cases 95% CI were used. Data was collected for a comprehensive oncology center (CCC) with all treatment modalities (RT, CTX, surgery), and 2nd level (2 treatment options available) and 1st level hospitals (1 option). The percentage of deaths within 30 days from the end of palliative RT in CS IV (F_4) was 8.7% for colorectal cancer, 21.8% for lung cancer 4.7% for breast cancer, 0% for ovarian cancer and 3.6% for prostate cancer in CCC. The % of pts requiring hospitalization due to side effects after RT (F_6) was 0% for colorectal, lung, ovarian, prostate cancer and 0-1.3% for breast cancer in CCC. For F_4 and F_6 QI, the data for the 1st and 2nd level hospitals was characterized by very low reporting. The % of pts with CS III rectal cancer who received preoperative RT (F_16) was 82.8% CI 73-90% for CCC, 54.3% CI 43-65%, for 2nd level and 100% CI 31-100% for 1st level hospitals. The % of pts with CS III NSCLC who received CRT (F_25) was 11.3% CI 8-16% for CCC, 0% CI 0-3% for 2nd level, 0% CI 0-9% for 1st level hospitals. The results of oncological treatment regarding the effectiveness, including survival, can be evaluated years after the treatment. QI allow for continuous ongoing evaluation of the diagnostic and therapeutic pts pathway, including individual treatment methods. RT as part of combined preoperative or curative treatment is an excellent nominator for QI, and met the appropriate % of a target value indicator which allows to be sure that comprehensive treatment will be offered to the most pts. The pilot program was the 1st joint action in Poland in which QI were collected, and the experience of the pilot participants allows for making recommendations regarding creating a network throughout benchmarking the data in the whole country.