Aims
Cancer Australia’s principles of best practice in lung cancer include multidisciplinary care and data-driven improvements in care. Our aim was to use data collected by the multidisciplinary team (MDT) to measure and report lung cancer quality indicators (QIs).
Methods
Seventeen published QIs relevant to the MDT were selected for measurement after a previous Delphi process and local consensus. Twelve were feasible to measure using Lung MDT data recorded in MOSAIQ. This included timeliness of care measures, documentation of pathology and ECOG performance status and guideline treatment for Stage I-III Non-Small Cell Lung Cancer (NSCLC) and all stages of Small Cell Lung Cancer (SCLC). Six monthly QI reports are generated for MDT feedback.
Results
There were 1119 patients with new lung cancer diagnoses in MOSAIQ from 2018-2020. Of 330 assessable patients, 83-95% had GP referral to specialist time ≤ 14 days, and of 266 assessable patients, 35-50% had GP referral to treatment time ≤ 42 days. All patients were assessable for the remaining QIs. Benchmarks were always met for the following QIs: MDT discussion (69-71%), pathological confirmation of diagnosis (91-95%), radiotherapy for inoperable Stage I&II NSCLC (79-95%), chemoradiotherapy in Stage IIIA NSCLC (50-93%) and chemotherapy for SCLC (74-93%). Benchmarks were variably met for the following QIs: adjuvant chemotherapy within 60 days in Stage pIIIA NSCLC (60-100%), chemotherapy within 14 days for SCLC (25-68%), chemoradiotherapy for Stage I-III SCLC (47-67%) and surgery for Stage I-II NSCLC (44-62%). Benchmarks were not met for documentation of ECOG performance status (61-77%). Patients not having guideline treatment all had valid reasons including patient preference, comorbidities and poor performance status.
Conclusions
Regular measurement and feedback of QIs is being used to improve lung cancer MDT care. Benchmarks for timeliness of care QIs remain challenging to meet.