Setting the bar: compliance with ovarian cancer quality indicators at a NCI-designated Comprehensive Cancer Center

abstract
 

Highlights

• •Appropriate quality indicator thresholds must take into account our complex patients
• •Complete surgical staging and timely administration of chemotherapy warrant attention
• •Existing perioperative quality measures demonstrate excellent compliance

Objectives

Ovarian cancer quality measures are being developed to improve health care delivery and outcomes. Our objective is to evaluate compliance with 8 quality indicators proposed by the Society of Gynecologic Oncology.

Methods

Review of 123 ovarian cancer patients who underwent primary surgical staging/cytoreduction and chemotherapy from 2010–2012 was undertaken. Medical records were reviewed, and descriptive statistics were performed to determine compliance.

Results

A timely operative report documenting residual disease was dictated for 121/123 (98.4%) patients. Complete surgical staging was performed in 33/55 (60.0%) stage I-IIIB patients, with lymphadenectomy most frequently omitted. For optimally debulked stage III patients, 52/56 (92.9%) were offered intraperitoneal chemotherapy. Ultimately, 29/56 (51.8%) received this route and 19/56 (33.9%) within 42 days (range 18–48, median 40 days). Clinical trial randomization and co-morbidities accounted for most cases of non-compliance. All 105 patients for whom chemotherapy was indicated received platin/taxane therapy, and 79/105 (75.2%) within 42 days (range 4–82, median 37 days). Venous thromboembolism prophylaxis was provided mechanically in 122/123 (99.2%) and pharmacologically in 99/123 (80.5%) patients within 24 hours of surgery. Prophylactic parenteral antibiotics were administered within 60 minutes of cytoreduction in 119/123 (96.7%) and discontinued within 24 hours after surgery in 120/123 (97.6%) cases.

Conclusions

Compliance with strict definitions of ovarian cancer quality indicators varies depending on the care delivered and documentation of that care. Increased attention to comprehensive surgical staging and timely initiation of chemotherapy appears warranted. With the move toward value-based payment models, quality indicators will play a significant role in health care delivery.