Quality Of Cancer Care Research Articles

Quality metrics at scale: Deriving time to first cancer treatment from electronic health records.

580 Background: Measurements of cancer care quality are critical for internal administration and participation in value-based care programs, towards the goal of improving patient outcomes. Data from electronic health records (EHRs) have the potential to allow for automatic computation of quality measures at a larger scale than manual chart review. This requires the creation of algorithms that process data and apply custom logic to define a clinically meaningful measurement. In this work, we describe the development and performance of an algorithm for deriving time from first primary oncologist visit to first cancer treatment using EHR data. Methods: This EHR-derived measure of time to first treatment (TTT) was implemented at an academic medical center for all patients who had a visit since 01/01/2011 and a cancer-related diagnosis code. We defined a patient’s primary oncologist as the first medical oncologist who they visited at least 5 times. These criteria were chosen to find the first provider at the site who the patient likely established care with and received treatment from. Then the patient’s TTT is computed as the number of days between their first visit date with this oncologist and the date of their first antineoplastic drug administration. Data on other treatment modalities, such as surgery and radiation therapy, were not available at the time of algorithm development. We allow for patients to receive their first treatment up to 60 days before their first visit to account for inpatient treatments before a primary outpatient oncologist is established. This algorithm’s performance was assessed through manual chart review among a sample of 38 patients. Results: Our algorithm correctly assigned 37 out of 38 patients (97.4%) to their primary oncologist, and computed the correct TTT for 28 out of 38 patients (73.4%). Incorrect TTT computations were mostly due to missingness of systemic therapy administrations in the structured EHR data; these were primarily for oral therapies. Conclusions: This work demonstrates the feasibility of measuring a patient’s TTT from structured EHR data alone. In particular, a patient’s initial visit with their primary oncologist can be derived with high accuracy. From this index date, the accuracy of the metric is dependent on the availability of structured treatment data. To further improve the EHR-derived metric, future work should incorporate other treatment modalities through structured data sources such as billing codes, and improve completeness of systemic therapy data in a scalable way, such as from natural language processing techniques.[Table: see text]

Disparities in time to initiation of treatment among patients with metastatic solid tumors in Washington state.

153 Background: Timely initiation of cancer treatment can improve quality of life and survival. As part of a large, statewide effort aimed at improving cancer care quality, we estimated time from diagnosis to initial treatment among patients with newly diagnosed metastatic cancers. Methods: Using an established linkage of Washington state cancer registry records with claims data from commercial insurers, Medicare, and Medicaid, we identified patients diagnosed with metastatic solid tumors diagnosed between 2017 and 2019. Time to first treatment with chemotherapy (CT), radiation therapy (RT) or hormone therapy (HT) was measured as the number of days from first visit at an oncology clinic to the date of first treatment. Patients seen at multiple oncology clinics were assigned to the clinic with the greatest number of physician visits. We used linear regression to evaluate factors associated with timeliness of care (tumor type, age, sex, race/ethnicity, insurance type, resident neighborhood deprivation, comorbidity). Results: 3,237 patients met inclusion criteria with median time to initial treatment of 34 days (CT 35 days; RT 28 days; HT 37 days). Mean time to treatment was 45.2 days (CT 47.6 days; RT 39.4 days; HT 49.0 days). Factors that were significantly associated with time to initiation of treatment are shown in the Table. Conclusions: Black and Medicaid-enrolled patients with metastatic cancers experience significantly longer times to first treatment. Future research will focus on identifying factors underlying the observed differences so that interventions can be designed to reduce these disparities.[Table: see text]

Establishing purposeful oncology care disparities reduction strategies.

166 Background: Quality thought leaders have noted the oneness of care quality and equity. Yet, quality improvement (QI) often ignores equity. We implemented a holistic approach to quality specifically designed to facilitate equity. We report the components of the approach and how it is being used to address disparities in unplanned acute care events (ACEs) among chemotherapy patients. Methods: We used the Institute for Health Improvement Whole System Quality framework to integrate care equity in an established quality program. We started by stratifying oncology dashboards by race, ethnicity, and language (REAL) as well as other factors (monitoring). We developed and implemented an Umbrella Action Plan Policy that specified an accountability structure to identify and address disparities (planning) and via goal setting (planning), prioritized, developed, and executed action plans to address disparities once identified (improvement). Results: In February 2023 a system-level senior leadership committee charged with priority setting cancer care quality initiatives approved the Umbrella Action Policy. This led to REAL-stratified, quarterly performance reports being shared with senior leadership who voted for this year’s annual goals to include identification and use of rapid cycle testing to eliminate ACE disparities. The organization-level goal engendered central QI coaching resources, established local entity QI teams within each System-affiliated entity with dedicated oncology program (N=6), and formed a learning collaborative across entities. One of each local QI team chose to focus on reducing race-related, language-related, and payor-related (Medicaid) disparities. The other organizations chose otherwise (e.g., age or gender). Teams are using two approaches to identify ACE root causes among target populations: (1) a structured chart abstraction form to search for, among other things, communication breakdowns, gaps in symptom management or other supportive care, and access barriers; and (2) a semi-structured interview guide to engage patients and caregivers for input and suggestions. In September, teams will work collaboratively to identify and execute small tests of change to alleviate identified drivers contributing to ACE disparities. Data from chart abstractions and patient engagement interviews will be shared along with results from tests of change tried to date. Conclusions: Facilitating the identification of disparities via REAL stratified dashboards, leadership teams setting expectations regarding gap closure, and allocation of resources to support local QI teams has focused the quality planning, monitoring, and, to some extent, improvement activities on care equity among marginalized populations. Prescriptively focusing local organization efforts may be needed for appropriate selection of target populations when wanting to infuse REAL equity in QI programming.

Quality of End-of-Life Care Among Adolescents and Young Adults With Cancer.

Adolescents, young adults with cancer receive limited psychosocial and spiritual support near death.

The caring experiences of family caregivers for patients with advanced cancer in Uganda: A qualitative study.

Cancer morbidity and mortality is rising in sub-Saharan Africa. Given this rise, family caregivers play an integral role in provision of quality cancer care services. This study explored the family caregivers (FCGs)/relatives' experiences of caring for patients with advanced cancer (stage 3 or stage 4) in Uganda. This was a descriptive qualitative study exploring the lived experiences of FCGs of patients with advanced cancer attending care at the Uganda cancer institute. We purposively recruited twelve FCGs and conducted face-to-face in-depth interviews using an interviewer-guided semi-structured questionnaire. Data were analyzed by thematic analysis. The age range of participants was 19 to 49 years. Most participants were children of the patients (n = 7), had attained tertiary education (n = 7), and had taken care of their loved ones for at least one year (n = 10). Six themes emerged from data analysis; (i) caring roles, (ii) caring burdens, (iii) role conflict, (iv) health system tensions, (v) support and motivation, (vi) caring benefits, lessons and recommendations. Study findings highlight the fundamental role of FCGs in the care of their loved ones, and illuminate the neglected physical, psychological and social challenges of family caregivers amidst health system tensions and conflicting roles. The needs of family caregivers should be embedded within cancer care, prevention and control programs particularly in low resource settings.

International Variations in Surgical Morbidity and Mortality Post Gynaecological Oncology Surgery: A Global Gynaecological Oncology Surgical Outcomes Collaborative Led Study (GO SOAR1).

Gynaecological malignancies affect women in low and middle income countries (LMICs) at disproportionately higher rates compared with high income countries (HICs) with little known about variations in access, quality, and outcomes in global cancer care. Our study aims to evaluate international variation in post-operative morbidity and mortality following gynaecological oncology surgery between HIC and LMIC settings. Study design consisted of a multicentre, international prospective cohort study of women undergoing surgery for gynaecological malignancies (NCT04579861). Multilevel logistic regression determined relationships within three-level nested-models of patients within hospitals/countries. We enrolled 1820 patients from 73 hospitals in 27 countries. Minor morbidity (Clavien-Dindo I-II) was 26.5% (178/672) and 26.5% (267/1009), whilst major morbidity (Clavien-Dindo III-V) was 8.2% (55/672) and 7% (71/1009) for LMICs/HICs, respectively. Higher minor morbidity was associated with pre-operative mechanical bowel preparation (OR = 1.474, 95%CI = 1.054-2.061, p = 0.023), longer surgeries (OR = 1.253, 95%CI = 1.066-1.472, p = 0.006), greater blood loss (OR = 1.274, 95%CI = 1.081-1.502, p = 0.004). Higher major morbidity was associated with longer surgeries (OR = 1.37, 95%CI = 1.128-1.664, p = 0.002), greater blood loss (OR = 1.398, 95%CI = 1.175-1.664, p ≤ 0.001), and seniority of lead surgeon, with junior surgeons three times more likely to have a major complication (OR = 2.982, 95%CI = 1.509-5.894, p = 0.002). Of all surgeries, 50% versus 25% were performed by junior surgeons in LMICs/HICs, respectively. We conclude that LMICs and HICs were associated with similar post-operative major morbidity. Capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention.

Provision of medical care to cancer patients in Ukraine during Russo-Ukrainian war: A survey of oncologists’ perceptions

ABSTRACT Background On February 24th, 2022, a full-scale armed conflict broke out in Ukraine, resulting in a significant impact on the healthcare system, as well as extensive damage to the country's infrastructure. The aim of this study was to assess the challenges faced by oncologists in providing cancer care to patients. Methods Data were collected through a structured self-administered questionnaire administered using the Google survey tool and distributed to all participants. Results This was a cross-sectional study that involved 111 oncology specialists. Physicians practising in regions that were partially or temporarily occupied by the Russian army (Chernihiv and Zaporizhzhia) reported a significantly higher decline in patient numbers compared to physicians in unoccupied regions (70.0% vs 20.9%; p < 0.0001). Most physicians from both occupied and unoccupied regions reported an increase in the number of patients with advanced disease (65.0% vs. 65.9%; p = 0.735). The majority of physicians from both occupied and unoccupied regions did not see loss of information, changes in cancer treatment phases, and self-medication as a concern. The majority were satisfied with the availability of medicines and equipment. Conclusion This needs-based assessment is crucial for improving the quality of cancer care as it provides valuable information for designing public health interventions.

Creating a culture for change: Lessons from behavioral economics and complexity science to increase serious illness conversations for patients with cancer

Patient-centered cancer care requires communication between patients and clinicians about patients’ goals, values, and preferences. Serious illness communication improves patient and caregiver outcomes, the value and quality of cancer care, and the well-being of clinicians. Despite these benefits, there are competing factors including time, capacity, bandwidth, and resistance. Health systems and oncology practices have opportunities to invest in pathways that assist patients and clinicians to engage in serious illness conversations. We discuss how applying insights from behavioral economics and complexity science may help clinicians engage in serious illness conversation and improve patient-centered cancer care.

Association of Managed Medicaid Plans and Cancer Stage at Diagnosis

Managed care organizations provide insurance to many Medicare (Advantage) and Medicaid beneficiaries and seek to maintain quality while controlling provider networks, utilization, and costs. In prior research, patients with Medicare Advantage plans had restricted access to care, including at cancer centers, and had higher mortality after cancer surgery than patients with traditional Medicare. Over 80% of Medicaid patients nationally are enrolled in managed care plans; despite their prevalence, there is a paucity of evidence regarding the quality of cancer care provided by these plans. We examined associations of state-level managed Medicaid rates and cancer stage at diagnosis. Adults ages 18-64 years with Medicaid coverage diagnosed with cancer from 2007-2016 were identified from Surveillance, Epidemiology, and End Results program data covering 12 states. Note that 2016 was the last year with unsuppressed insurance status data. Year-varying state-level rates of types of managed Medicaid plans (comprehensive risk-based managed care, limited benefit plans, and primary care case management) were obtained from the Medicaid and CHIP Payment and Access Commission and categorized in quartiles. The association of state levels of each type of managed Medicaid plan with localized stage diagnoses was evaluated using multivariable linear probability models with cluster-robust standard errors (state clusters) accounting for state fixed effects, year fixed effects, age, sex, race, metropolitan residence, marital status, county-level income and education, state Medicaid expansion status, and cancer type. A total of 229,227 Medicaid patients were identified. The average state-level rates of comprehensive managed care, limited benefit, and primary care case management plans were 47%, 47%, and 5.6%, respectively. In adjusted analyses, relative to states with <20% of Medicaid recipients enrolled in comprehensive managed care plans, states with 40-80% (-2.07 percentage points, 95% CI = -3.31 to -0.83, P = .001) and >80% (-1.49, 95% CI = -2.49 to -0.50, P = .003) had fewer localized stage diagnoses. States with >2% relative to 0-1% of recipients enrolled in primary care case management plans had more localized stage diagnoses (1.02, 95% CI = 0.27 to 1.77, P = .008). States with higher levels of limited benefit plans had more localized stage diagnoses (P = .011), though associations were attenuated with increasing levels (20-40%: 1.22; 40-80%: 0.53; >80%: 0.40). Patterns were similar across most cancer types. The prevalence and type of Medicaid managed care plans are associated with early-stage cancer diagnoses. Higher levels of comprehensive managed care plans were associated with fewer early diagnoses, raising concerns about barriers to symptom evaluation and diagnostic workup. In contrast, higher levels of primary care case management plans were associated with more early diagnoses, potentially through streamlined care coordination.

Radiotherapy Capabilities, Population, Average Income, and Health Insurance Status as Predictors of Cancer Mortality at the County Level in the United States

Sufficient radiotherapy capacity at the country level is commonly seen in high income countries and is an essential factor in access to high quality cancer care. However, universal access is not always possible due to other factors beyond the commonly used parameter of machines per million population. This study aims to assess the barriers cancer patients in a high-income country face in accessing radiotherapy, and how this impacts cancer mortality. This cross-sectional study utilized United States county level oncologic and demographic data obtained from Centers for Disease Control and Prevention and the International Atomic Energy Agency Directory of Radiotherapy Centers. Radiotherapy facilities in the United States were mapped using Geographic Information Systems software. Univariate analysis was used to identify whether distance to a radiotherapy center or various socioeconomic factors were predictive of all-cancer mortality-to-incidence ratios. Variables that were deemed to be significant (p ≤ 0.05) on univariate analysis were then included in a step-wise backwards elimination method of multiple regression analysis. Among the United States counties studied, 31.3% of counties have at least one radiotherapy facility and 8.3% have five or more radiotherapy facilities. Median linear distance from a county's centroid to the nearest radiotherapy center was 36 Km and the median county all-cancer mortality to incidence ratio (MIR) was 0.37. The ratio of radiotherapy centers, linear accelerators and brachy therapy units per 1 million people were significantly associated with all-cancer MIR (p<0.05). Greater distance to radiotherapy facilities, lower county population, lower average income per county, and higher proportion of patients without health insurance were statistically significant predictors of increased all-cancer MIR (R-squared: 0.2113, F = 94.22, p<0.001). This analysis used unique high-quality datasets to identify significant barriers to radiotherapy access that correspond to higher cancer mortality at the county level. Geographic access, personal income, and insurance status all contribute to these concerning disparities. Efforts and novel strategies to address and minimize these barriers are needed to ensure access to care and improve oncologic outcomes.

Association Between Urologist Merit-Based Incentive Payment System Performance and Quality of Prostate Cancer Care.

We performed a study to evaluate the association between urologist performance in the Merit-Based Incentive Payment System (MIPS), and quality and spending for prostate cancer care. Medicare beneficiaries with prostate cancer diagnosed between 2017 and 2019 were assigned to their primary urologist. Associated MIPS scores were identified and categorized based on thresholds for payment adjustment as low (worst), moderate, and high (best). Multivariable mixed effects models were used to measure the association between MIPS performance and adherence to quality measures and price standardized spending for prostate cancer. Adherence to quality measures did not vary across MIPS performance groups for pretreatment counselling by both a urologist and radiation oncologist (low-76%, [95% CI 73%-80%], moderate-77% [95% CI 74%-79%], and high-75% [95% CI 74%-76%]) and avoiding treatment in men with a high risk of noncancer mortality within 10 years of diagnosis (low-40% [95% CI 35%-45%], moderate-39% [95% CI 36%-43%], high-38% [95% CI 36%-39%]). Men on active surveillance managed by high performers more likely received a confirmatory test (44% [95% CI 43%-46%]) compared to those managed by moderate (38% [95% CI 33%-42%]) performers, but not low performers (36% [95% CI 29%-44%]). There was no difference in adjusted spending across MIPS performance groups. Better performance in MIPS is associated with a higher rate of confirmatory testing in men initiating active surveillance for prostate cancer. However, performance was not associated with other dimensions of quality nor spending.

Designing and validating novel communication measures for pediatric, adolescent, and young adult oncology care and research: The PedCOM measures.

High-quality communication in pediatric and adolescent cancer is the standard of care. Yet, we lack pediatric-specific communication measures. We designed self-report and caregiver-report communication measures for use in pediatric oncology settings. We recruited adolescent and young adults (AYAs; 12-24years) with cancer and parents of children and AYAs between 1month post-diagnosis and 2months after completing treatment. Participants completed measures including 58 questions addressing eight previously characterized communication functions. For each function, we conducted factor analysis, and assessed reliability and construct validity. Based on psychometric properties, we created final long-form (31 items) and short-form (eight items) communication measures (PedCOM) for both self- and caregiver-report. Participants included 200 parents and 88 AYAs. The final 31-item and eight-item PedCOM measures for parents and AYAs demonstrated good unidimensional model fit. Each communication function (e.g., building relationships) demonstrated high reliability, coefficient alphas ranged from .83 to .93 for parents and .85 to .93 for AYAs. The overall 31-item and eight-item PedCOM measures also demonstrated high reliability (alphas >.9). For construct validity, PedCOM-Parent-31 and PedCOM-Parent-8 correlated positively with satisfaction with care, trust, emotional self-management, and decisional satisfaction, and negatively with anxiety and caregiver burden. PedCOM-AYA-31 and PedCOM-AYA-8 correlated positively with satisfaction with care, trust, emotional self-management, symptoms self-management, and decisional satisfaction, and negatively with anxiety. We developed valid and reliable measures of communication functions for parents and AYAs with cancer. These measures can support organizations and stakeholder groups that are striving to improve the quality of cancer care.

Estimating remaining life expectancy in veterans with basal cell carcinoma using an automated electronic health record scoring system: A retrospective cohort study

Active surveillance may be considered for low-risk basal cell carcinomas (BCCs) in patients with limited life expectancy; however, estimates of life expectancy are not readily available. Veterans Health Administration's Care Assessment Need (CAN) score may address this problem. We examined the CAN score's performance in predicting 1-, 3-, and 5-year mortality in US veterans with BCC. This retrospective cohort study used national Veterans Health Administration's electronic medical record data. The CAN score's performance in the prediction of mortality in veterans with BCC was evaluated based on tests of goodness-of-fit, discrimination, and calibration. For 54,744 veterans with BCC treatment encounters between 2013 and 2018, the CAN score performed well in the prediction of mortality based on multiple tests. A threshold CAN score of 90 had a positive predictive value of 55% for 3-year mortality, clinically useful in identifying patients with intermediate-term survival. The study relied upon the combination of diagnosis codes and procedure codes to identify BCC cases. The CAN score has the potential to improve the quality of cancer care for veterans by providing clinicians with an estimate of life expectancy and facilitating conversations in cases where active surveillance can be considered.

Disparities and barriers in the assessment of psychological distress, access to and use of psycho-oncological support in Europe: current perspectives.

The implementation of psycho-oncological support has shown important results in positively influencing treatment outcomes and quality of life in cancer patients and survivors. In the last few decades, the importance of mental health has been brought to attention to the general public and healthcare professionals on a national, institutional and organisational level. Official guidelines, policies, and training programs have been developed suggesting that psycho-oncological support should be considered as a non-negotiable requirement for quality cancer care in many hospitals and clinical centres across Europe. Health organisations, associations, institutions, and societies, such as the International Psycho-Oncology Society (IPOS) and the European Partnership for Action Against Cancer (EPAAC), are forming alliances, funding research projects and organising congresses in order to study, understand, and discuss the reasons for barriers and disparities in psycho-oncological support and, eventually, to overcome the existing cancer divide. Nevertheless, the World Health Organization's (WHO) estimations indicate that the cancer burden is still increasing, and relevant barriers and disparities in accessing psycho-oncological support continue to exist and influence the health conditions and quality of life of cancer patients and survivors. The present work will present the current disparities and barriers regarding assessment, access to and use of psycho-oncological support in the countries of the European Union, making suggestions for further research and possible solutions.

Compassion Fatigue in Nurses Providing Palliative Cancer Care and Coping Strategies to Prevent and Manage it

End-of-life care for cancer patients is one of the most challenging experiences encountered by nurses. Cancer nurses providing end-of-life care may experience compassion fatigue due to prolonged exposure to the suffering and intense emotional reactions of patients, death and the dying, and grieving families. However, the development of resilience and effective coping skills can decrease nurse turnover rates and increase the quality of palliative cancer care. This article discusses the concept of compassion fatigue, how it develops, compassion fatigue experienced by nurses providing palliative cancer care, and the Compassion Fatigue Resiliency Program (CFRP) coping method. Author experience and journal articles were used. Compassion fatigue can occur from secondary traumatic stress and burnout after nurses' prolonged and intense exposure to helping suffering patients, resulting in decreased ability to care, expend energy, or exhibit empathy and compassion. The CFRP is a structured, comprehensive training program designed to educate nurses about compassion fatigue and enable them to develop a support network, strengthen their coping skills, and improve resilience. It is recommended that the CFRP be included in in-service training in institutions and be applied to oncology nurses at regular intervals in a block program format (1-2 days). Newly recruited oncology nurses in particular should be supported with such training in orientation programs. Institutional managers play an important role in organizing such programs and screening for the risk of compassion fatigue in nurses who provide end-of-life care.

Patient safety culture predictors and outcomes for sustainable oncology nursing practice: A cross-sectional correlational study.

To examine the predictors and outcomes of patient safety culture (PSC) among oncology nurses working in public Saudi hospitals according to participant characteristics and evaluate the relationship between PSC domains. PSC is crucial in healthcare systems, particularly in oncology and chemotherapy units, and its assessment can enhance the standard service provided and cancer care quality. There is currently limited research on the status, predictors and outcomes of PSC in cancer care settings in developing countries, including Saudi Arabia. A cross-sectional correlational study. A convenience sample of 101 oncology nurses working in two large Saudi tertiary care hospitals participated in this study. The Hospital Survey on Patient Safety Culture validated instrument and demographic and work surveys were completed by the participants. The study methods were compliant with the STROBE checklist. Descriptive statistics and multiple linear regressions were used to analyse the data. The areas of PSC strength were related to organizational learning-constant improvement, feedback and communication about errors, and transitions and handoffs. Manager/supervisor actions and expectations, hospital management support, communication openness, experience in the current unit and oncology unit/area were the predictors of PSC. In terms of PSC outcomes, the oncology nurses reported either no or one to two adverse events and a substantially good patient safety rating. The level of PSC was lower than expected. Communication openness, experience in the current unit and oncology unit/area were the strongest predictors of PSC. Investing in oncology nursing practice that addresses these concerns and prioritizes patient safety is critical in Saudi cancer care settings to increase patient safety. The findings contribute to a better understanding of the predictors and outcomes of PSC, which should be considered when establishing effective nursing interventions or strategies for PSC in cancer care settings. No patient or public contribution.

Association of Delay in Breast Cancer Diagnosis With Survival in Addis Ababa, Ethiopia: A Prospective Cohort Study.

There are limited data on the association between delay in breast cancer diagnosis after breast symptom recognition and survival, particularly in sub-Saharan Africa. The recently launched Global Breast Cancer Initiative by WHO includes measuring delay as the core indicator for quality of breast cancer care. Herein, we examined the association between delay in breast cancer diagnosis with overall survival among women in Addis Ababa, Ethiopia. A total of 439 women diagnosed with breast cancer from January 1, 2017, to June 30, 2018, in Addis Ababa were followed for survival to the end of 2019. Survival rates were estimated using the Kaplan-Meier method. The association between delay in diagnosis (>3 months after symptom recognition) and overall survival was computed using the multivariable Cox regression model after adjusting for demographic and clinical factors. Nearly 70% (303/439) of women with breast cancer were delayed in diagnosis of their cancer. During a median follow-up period of 25.1 months, 2-year overall survival rate was 73.5% (95% CI, 68.0 to 78.2) in women with diagnosis delay compared with 79.1% (95% CI, 71.2 to 85.1) in those women without diagnosis delay. In the multivariable Cox regression model, the risk of death was 73% higher (hazard ratio, 1.73; 95% CI, 1.09 to 2.74) in women with diagnosis delay compared with those without diagnosis delay. Delay in diagnostic confirmation of breast cancer after recognition of breast symptoms was negatively associated with overall survival in Addis Ababa, Ethiopia, underscoring the need to increase awareness about the importance of prompt presentation for clinical evaluation and referral for diagnostic confirmation to mitigate the undue high burden of the disease.

The association of cervical cancer screening and quality of care: A systematic analysis of the Global Burden of Disease Study 2019.

Improving the quality of care is vital to enhance outcomes for cervical cancer patients. However, the inequality of cervical cancer care was seldomly assessed. We collected the data of cervical cancer burden from the Global Burden of Disease 2019 database, and constructed the Quality of Care Index (QCI) using principle component analysis. Then the disparity of QCI across regions and populations were evaluated. The association between cervical cancer screening coverage and QCI weas also explored. Quality of cervical cancer care was of disparity across regions with different development levels, with a widening gap between low-income regions and others. Cervical cancer QCI dropped rapidly after the age of 35. Cervical cancer screening coverage was positively associated with QCI, and this association was stronger in countries with low- and middle-development levels. Regions with a low development level and the middle-aged women were vulnerable in QCI improvement. Higher screening coverage was associated with better cervical cancer QCI, implying that expanding cervical cancer screening coverage may be an effective strategy to improve the quality of cervical cancer care.

WTP7.14 The ‘Right’ Strategy? Can we change the risk profile of emergency presentations of right sided colorectal cancers?

Abstract Background Up to 30% of patients with colorectal cancer present acutely and have worse outcomes than elective patients. We sought to compare cancer care quality and clinical outcomes between emergency and elective presentations of right-sided colon cancer. Methods This single-centre, retrospective study included all patients who underwent operative management (emergency and elective) for a right-sided colon cancer, from 1st April 2017 to 31st March 2022. Data were collected from electronic patient records and analysed to compare host and tumour factors as well as outcomes between emergency and elective cohorts. Results Overall 303 patients (median age 72) were included. 65 patients (22%) presented as an emergency: 36 presented in obstruction and 11 with tumour perforation, compared to 1 patient with tumour perforation in the elective group (p=&amp;lt;0.0001). Emergency presentation was associated with more advanced tumour stage (p=0.001). The emergency group had lower rates of laparoscopic surgery (32% vs 86% p=&amp;lt;0.0001); higher rates of post-operative complications (47% vs 27% p=0.05); increased 90-day mortality (20% vs 3% p=0.001); and a longer hospital stay (9 vs 4 days p=0.048). 50% of emergency patients received adjuvant chemotherapy compared to 56% of elective patients (p=0.71). No differences were found between the two groups regarding demographics, comorbidities, or time to MDT discussion. Discussion Outcomes of acute right-hemicolectomy are poor, with inadequate access to subsequent chemotherapy. Strategies addressing acute presentations of left-sided tumours have moved towards temporisation and elective surgery; this strategy is rarely adopted for acute presentations of right-sided tumours. Delaying major resectional surgery for optimisation may improve short-term outcomes, and access to adjuvant therapies.

Quality of Care for Prostate Cancer in Kashmir, India: A Real-World Study.

Purpose Despite the importance of quality care for patients with prostate cancer, significant gaps exist in healthcare delivery, including diagnosis and treatment. Our objective was to assess the quality of care (QoC) using retrospective data from prostate care patients in our center. Methods We performed a retrospective study of prostate cancer patients registered at a dedicated cancer care center in the Kashmir region from 2012 to 2020. A set of 15 quality indicators representing crucial facets of diagnosis, pathology, and treatment was identified from a comprehensive list developed and validated by other researchers. Results The final analysis of all indicators was conducted on 46 patients with a median age of 70 years (52-92 years). In the majority of patients, the diagnosis (89.1%) was made through a prostatic biopsy, while only five patients were diagnosed solely based on the prostate-specific antigen. Transrectal ultrasound (TRUS) or transurethral resection (TURP)-guided biopsy was documented in 84.8% of patients, with Gleason grading documented in 87.5% of patients. However, the number of positive cores was mentioned for only 25.7% of patients. Radical prostatectomy was the primary treatment for most patients with localized prostate cancer (58.3%). The majority of patients with metastatic prostate cancer were treated with orchidectomy (55%), owing to easy access and the lower cost of surgical castration. Conclusion The study demonstrated a lack of compliance with many QoC indicators at the diagnostic and therapeutic levels. However, large-scale, population-based studies are needed to establish the compliance of prostate cancer QoC in Kashmir. The quality indicator assessment can guide the necessary actions required to improve QoC for prostate cancer patients.