Oncologists and researchers agree there are some gaps in their data, and are looking at ways to develop smarter care metrics—not more of them.
Cancer isn't one disease. It can be acute or it can be chronic. Treatment options vary, and they can be delivered by multiple providers across numerous care settings.
These variations have made it difficult for oncologists and medical researchers to develop meaningful quality measures for cancer care.
Their observations were validated two years ago by an Institute of Medicine report that concluded: "no current quality reporting program or set of measures adequately assesses cancer care in a comprehensive, patient-oriented way."
Many in the business of developing and approving quality measures for cancer care agree with the IOM's assessment that current measures don't provide a complete picture.
Along with the growing consensus that a better way to collect patient-reported outcomes data is needed comes a greater push to develop cross-cutting quality measures.
Patchwork Measures
Many cancer care quality measures were initially developed by professional and specialty groups for their own needs, so the landscape of measures looks like a patchwork, said Tracy Spinks, program director for cancer care delivery at the University of Texas MD Anderson Cancer Center in Houston.
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Spinks sees a need for both general and disease-specific quality measures. Providers could look broadly at measures such as functional status and quality of life during chemotherapy, she said.
Risk would vary with different treatment regimens, but all patients going through chemotherapy are expected to have fatigue, nausea and pain. "When it comes to functional status, it is really going to be dependent on the disease," Spinks said.
"If we want to measure patient-reported outcomes, not just for a specific treatment but across all treatment modalities, that's where we found that focusing on [cancer] site-level [measures] makes sense."
Hospital staff should initiate an internal conversation about putting systems in place to collect patient-reported outcomes, Spinks said. As measures of those outcomes mature, they'll become a factor in value-based payment.
Wanted: Patient-Reported Outcomes
Measures are still evolving and cross-cutting measure are important, said Karen Fields, MD, Medical Director of Strategic Alliances at Moffitt Cancer Center in Tampa, FL, and co-chair of the National Quality Forum cancer committee.
The NQF is the clearinghouse for federal quality measures. Last summer it reviewed and revised performance measures for conditions including breast cancer, colon cancer, chemotherapy, leukemia, prostate cancer, and melanoma.
The NQF also reviewed measures for symptom management and end-of-life care.
However, the major gap in quality measures at the moment is lack of patient-reported outcomes, Fields said.
"If we don't add in patient-reported outcomes measures—[as in,] did we meet the patient's goals—then we've not looked into all of our opportunities to improve outcomes," she said.