The Dutch Lung Cancer Audit: Nationwide quality of care evaluation of lung cancer patients

Abstract

This study describes the initiation of the Dutch Lung Cancer Audit for Lung Oncology (DLCA-L) and reports the first results of three years of clinical auditing. Methods: The initiation, dataset, and data quality of the DLCA-L are described. For the analyses, all patients registered from 2017 to 2019 were included. Descriptive statistics were used to assess the first outcomes of the DLCA-L, including results from quality indicators, patient-and tumor characteristics, and the real-world use of immunotherapy. Results: The DLCA-L was initiated after the surgery and radiotherapy audit for lung cancer. In total, 33.788 NSCLC patients and 4.293 SCLC patients were registered in the DLCA-L from 2017 to 2019. Seventy-three (97 %) Dutch hospitals participated in the DLCA-L in 2019. The registry became nationwide in 2020. The data quality improved over the years, with complete cases in 90 % of the NSCLC patients. In total, 15 quality indicators were established based on DLCA-L data to improve processes and clinical outcomes. An example of these quality indicators was brain imaging at diagnosis of stage III NSCLC patients, which increased from 80 % in 2017 to 90 % in 2019 and hospital variation was reduced. The DLCA-L provided data on immunotherapy use in stage IV NSCLC (n = 4.415) patients. These patients had a median age of 67 years and 11 % of the patients had an ECOG PS ≥ 2. The number of patients treated with immunotherapy in different hospitals varied between 2 patients to 163 patients per hospital. Conclusion: The DLCA-L has become a valuable and complete data source with national coverage in 2020. A high number of registered patients and limited missing data resulted in better insights into hospital processes and outcomes of lung cancer care. Quality indicators were, with success, used to establish improvements and minimize hospital variation. The DLCA-L also provides hospitals real-world information on the use of (systemic) therapies.

The Impact of the Availability of Immunotherapy on Patterns of Care in Stage III NSCLC: A Dutch Multicenter Analysis

“…In comparison, results from the Dutch Lung Cancer Audit reported that the use of immunotherapy in stage III NSCLC was only 13% in 2018, but increased to 25% in 2019. 18 This finding could be explained by the fact that only a limited number of Dutch institutions were initially allowed to prescribe durvalumab. 18 Most centers participating in our study had early access to durvalumab for their patients, but durvalumab was recorded as being unavailable in 9% of eligible patients.…”

“… 18 This finding could be explained by the fact that only a limited number of Dutch institutions were initially allowed to prescribe durvalumab. 18 Most centers participating in our study had early access to durvalumab for their patients, but durvalumab was recorded as being unavailable in 9% of eligible patients. Our real-world data are consistent with other reports indicating only between 34% and 73% of patients receive durvalumab after CCRT, with similar reasons being cited for noncompliance.…”

Quality indicators for radiation oncology

“…7 Tumour specific oncology QIs are also reported in retrospective annual patterns of care audits by a number of countries. [8][9][10][11] An updated framework for modern cancer care was recently proposed by Chiew et al to incorporate 12 areas for quality of care expanding upon the Donabedian model of structural (timeliness, access and healthcare delivery systems) process (appropriateness of treatment, technical, multidisciplinary discussion/coordination of care, patient reported experiences (PRE) and satisfaction) and outcome domains (disease-specific survival, patient reported outcomes (PRO), safety and adverse events, with all areas also needing to include value and innovation/improvement. 12 Oncology QIs are commonly developed and derived via an established methodology of evidence-based literature search, modified Delphi process and expert consensus/concordance voting.…”

Relationship between Treatment Plan Dosimetry, Toxicity, and Survival following Intensity-Modulated Radiotherapy, with or without Chemotherapy, for Stage III Inoperable Non-Small Cell Lung Cancer

“…Stage III (locally advanced) non-small cell lung cancer (NSCLC) represents approximately 20% of all new lung cancer diagnoses [ 1 , 2 ]. Many patients are elderly with significant co-morbidities, and multidisciplinary tumor board review is recommended to determine the best treatment strategy [ 3 , 4 ].…”