Outpatient oncology practices that voluntarily participated in a quality-improvement program markedly increased their adoption of newly recommended treatments, but continued to do poorly in smoking cessation efforts and in discussing fertility preservation.
From the start and throughout the period studied, 156 oncology practices reported high rates of recommending adjuvant chemotherapy according to guidelines for breast, colorectal, or non–small cell lung cancer, Dr. Michael N. Neuss said in an online press conference sponsored by the American Society of Clinical Oncology (ASCO).
Courtesy American Society of Clinical Oncology
Dr. Michael N. Neuss
These participants in ASCO’s Quality Oncology Practice Initiative (QOPI) improved their mean overall scores for adherence to recommended care from 71% to 85%, Dr. Neuss and his associates reported. The study was to be presented at ASCO’s Quality Care Symposium in San Diego on Nov. 30, 2012.
Use of new clinical practices based on new guidelines or clinical evidence improved from 5% to 69% between 2006 and 2010. That’s "quite a remarkable improvement," said Dr. Neuss, chief medical officer at the Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tenn.
These new practices included pathologic examination of at least 12 regional lymph nodes for surgically resected colon cancer, which zoomed from nonexistent at the start of the study to 60% compliance within 6 months and 100% of practices complying after 5 years. Use of the antinausea drug aprepitant (Emend) improved from 20% of practices to 60%.
Clinicians were quick to adopt two clinical practices that were introduced during the study period. Genetic testing to predict response to treatment in patients with metastatic colorectal cancer increased from just over 60% of practices to more than 80%. Testing for KRAS gene alterations when administering anti–epidermal growth factor receptor therapy increased from approximately 55% to approximately 85% of practices.
Throughout the study, close to 90% or more of physicians reported recommendations for adjuvant chemotherapy that concorded with guidelines. "On many adjuvant treatment measures, it appears that QOPI participants are already doing very well," Dr. Neuss said.
In the areas of smoking and fertility, however, practices were resistant to change despite strong evidence promoting specific care. Although physicians documented patients’ smoking status 90%-95% of the time, rates of smoking cessation counseling topped out at about 35%.
"Similarly, there’s a good reason to tell people who may be rendered infertile by chemotherapy of this problem and of potential solutions to it," but no more than 30% of patients got discussions of infertility risks and only approximately 15% heard about fertility preservation options, Dr. Neuss said.
Data came from a larger cohort of approximately 2,000 physicians in 308 practices (comprising 15%-20% of U.S. oncologists) who participated in QOPI beta testing from 2006-2010. Twice yearly, physicians reviewed patients’ charts and filed a structured online report on an average of 100 preidentified measures that the QOPI uses to assess quality of care. Within 2 weeks, the practice would receive a report from QOPI on how the practice’s rates of compliance with recommended care compared with the ideal, rates for all practices in QOPI, and rates for practices similar to their own.
"It’s entirely up to you how you act on that result or ignore it," he said.
Each practice provided at least two rounds of data (averaging six rounds) and reported on 30 or more patients per round. The analysis looked at 50 measures of quality that did not change during the study period in seven modules – core quality measures, symptom management, end-of-life care, non-Hodgkin’s lymphoma, breast cancer, colorectal cancer, and non–small cell lung cancer.
The study excluded practices that did not provide a full data set, were located outside the United States, or that presented trainee data. The investigators developed a logistic regression model to accommodate varied performance at the start of QOPI, which normalized performance among groups and allowed assessment of each practice’s improvement.
QOPI has moved beyond beta testing and now includes more than 800 registered oncology practices participating, he said.
Dr. Neuss reported having no financial disclosures.