Quality Assurance in Oncology: Definition of Treatment Goal and Assessment of Its Achievement

Abstract

Background: Quality may be assured at 3 different levels: structure, process, and outcomes. In this paper we describe a method for assessing the quality of outcomes in the case of oncological recommendations for treatment. Material and Methods: For different therapies several goals were defined and the extent to which they were attained was evaluated. Several dimensions of the treatment goal were distinguished: the direction, specification and quantification of the goal. The direction may be either cure or palliation. If the goal is cure, the prolongation of life is intended. In the case of palliation as goal it should be specified whether alleviation of existing symptoms or prevention of impending problems is desired. Results: Based on 85 treatment recommendations provided by the Interdisciplinary Oncologic Conference of the Cancer Center University of Ulm we were able to demonstrate that a specification of palliative therapy was performed in 60% of all recommendations. The intended goal could actually be realized in half of these cases, i.e. in 30%. Conclusions: These data show that analysis of palliative therapy is a useful aid for assessing the rate of goal achievement and for modifying either the goals or the treatment if considered necessary.

Benefits and Risks of Breast Cancer Screening

“…The aim of secondary prevention is to prevent death from a disease such as breast cancer by detecting a suspicious lesion at a very early stage, confirming the suspected lesion by making a diagnosis, and finally treating the patient suffering from the confirmed early-stage disease with the goal of cure. The aim of tertiary prevention is to confirm a suspected diagnosis mostly in a non-curable (advanced) stage of disease and treating the patient to prevent new clinical problems or to stop the deterioration of already existing clinical problems [14]. This classification and description of healthcare strategies demonstrates that secondary prevention is the most complex strategy as it employs three different methods to achieve the final goal (table 3).…”

Palliative Therapies in Elderly Cancer Patients

“…To address the first of these questions, [67] we analysed 85 recommendations made from April 1992 through to June 1993 by the weekly Interdisziplinares Onkologisches Konsil of the Cancer Center VIm . As demonstrated in figure 2, 3 types of recommendations were analysed: recommendations with the goal of cure (n = 11), recommendations with the goal of palliation (n = 64) and recommendations for further investigation (n = 10).…”