Quality assurance of rectal cancer diagnosis and treatment - phase 3 : statistical methods to benchmark centres on a set of quality indicators

In 2004, the Belgian Section for Colorectal Surgery, a section of the Royal Belgian Society for Surgery, decided to start PROCARE (PROject on CAncer of the REctum), a multidisciplinary, profession-driven and decentralized project with as main objectives the reduction of diagnostic and therapeutic variability and improvement of outcome in patients with rectal cancer. All medical specialties involved in the care of rectal cancer established a multidisciplinary steering group in 2005. They agreed to approach the stated goal by means of treatment standardization through guidelines, implementation of these guidelines and quality assurance through registration and feedback. In 2007, the PROCARE guidelines were updated (Procare Phase I, KCE report 69). In 2008, a set of 40 process and outcome quality of care indicators (QCI) was developed and organized into 8 domains of care: general, diagnosis/staging, neoadjuvant treatment, surgery, adjuvant treatment, palliative treatment, follow-up and histopathologic examination. These QCIs were tested on the prospective PROCARE database and on an administrative (claims) database (Procare Phase II, KCE report 81). Afterwards, 4 QCIs were added by the PROCARE group. Centres have been receiving feedback from the PROCARE registry on these QCIs with a description of the distribution of the unadjusted centre-averaged observed measures and the centre’s position therein. To optimize this feedback, centres should ideally be informed of their risk-adjusted outcomes and be given some benchmarks. The PROCARE Phase III study is devoted to developing a methodology to achieve this feedback

Radiofrequency and Microwave Ablation Compared to Systemic Chemotherapy and to Partial Hepatectomy in the Treatment of Colorectal Liver Metastases:A Systematic Review and Meta-Analysis

To assess safety and outcome of radiofrequency ablation (RFA) and microwave ablation (MWA) as compared to systemic chemotherapy and partial hepatectomy (PH) in the treatment of colorectal liver metastases (CRLM). MEDLINE, Embase and the Cochrane Library were searched. Randomized trials and comparative observational studies with multivariate analysis and/or matching were included. Guidelines from National Guideline Clearinghouse and Guidelines International Network were assessed using the AGREE II instrument. The search revealed 3530 records; 328 were selected for full-text review; 48 were included: 8 systematic reviews, 2 randomized studies, 26 comparative observational studies, 2 guideline-articles and 10 case series; in addition 13 guidelines were evaluated. Literature to assess the effectiveness of ablation was limited. RFA + systemic chemotherapy was superior to chemotherapy alone. PH was superior to RFA alone but not to RFA + PH or to MWA. Compared to PH, RFA showed fewer complications, MWA did not. Outcomes were subject to residual confounding since ablation was only employed for unresectable disease. The results from the EORTC-CLOCC trial, the comparable survival for ablation + PH versus PH alone, the potential to induce long-term disease control and the low complication rate argue in favour of ablation over chemotherapy alone. Further randomized comparisons of ablation to current-day chemotherapy alone should therefore be considered unethical. Hence, the highest achievable level of evidence for unresectable CRLM seems reached. The apparent selection bias from previous studies and the superior safety profile mandate the setup of randomized controlled trials comparing ablation to surgery

Quality indicators for testicular cancer : A population-based study

1133-1140Purpose This study aimed at developing and measuring an indicator set to monitor the quality of testicular cancer care, to make comparisons over time and to support quality improvement for all practitioners and centres involved in the care of testicular cancer patients. Methods Quality indicators were identified from a systematic literature search and from the 2010 Belgian evidence-based clinical practice guidelines. The selection process involved an expert panel evaluating reliability, relevance, interpretability and actionability of each indicator. The quality indicators were pilot tested using the Belgian Cancer Registry (BCR) data linked with claims data for 1307 men with testicular cancer diagnosed between 2001 and 2006. The variability between centres was displayed using funnel plots. Results Of the 12 finally selected indicators, 5 were fully and 1 was partly measurable, while 2 indicators were measurable using proxy information. Five-year relative survival was 97%, 95% and 76% for pStage I–III, respectively. Overall 5-year survival slightly improved from 91% in 2001 to 94% in 2004. Between 2004 and 2006, 14 of 97 centres performed ⩾10 orchidectomies. Large variability was found between centres. The nine centres with a 5-year observed survival below the lower limit treated less than 20 patients between 2001 and 2006. Conclusions The present study demonstrates the feasibility to develop a multidisciplinary set of quality indicators for testicular cancer. Using national cancer registry data linked to claims data, eight indicators were measurable, showing a mixed picture of the quality of care for testicular cancer patients in Belgium

Vacuümgeassisteerde Wondbehandeling: een Rapid Assessment

iV, 71 p.ill

Evaluation rapide de technologies émergentes s'appliquant à la colonne vertébrale : remplacement de disque intervertébral et vertébro/cyphoplastie par ballonnet

vi, 50 p.ill

Proton beam therapy in adults : a systematic review

37 p.ill.,LIST OF TABLES 3 -- LIST OF ABBREVIATIONS 4 -- SCIENTIFIC REPORT 6 -- 1 INTRODUCTION 6 -- 1.1 BACKGROUND 6 -- 1.2 BELGIAN CONTEXT 6 -- 1.3 PROJECT SCOPE 7 -- 1.4 INCIDENCE AND PROGNOSIS .9 -- 1.5 AIM OF THE STUDY 9 -- 2 METHODOLOGY 10 -- 2.1 CLINICAL RESEARCH QUESTION 10 -- 2.2 LITERATURE SEARCH AND SELECTION .10 -- 2.3 QUALITY APPRAISAL AND DATA EXTRACTION 11 -- 2.3.1 Quality appraisal 11 -- 2.3.2 Data extraction 11 -- 2.4 STATISTICAL ANALYSIS 11 -- 2.5 GRADE .12 -- 3 RESULTS .12 -- 3.1 OVERVIEW OF SELECTED STUDIES .12 -- 3.2 SYSTEMATIC REVIEWS AND HTA REPORTS 18 -- 3.3 EFFECTIVENESS BY INDICATION 19 -- 3.3.1 Low-grade glioma .19 -- 3.3.2 Primary sinonasal tumours and recurrences of head & neck tumours .19 -- 3.3.3 Breast cancer 19 -- 3.3.4 Pancreatic cancer 19 -- 3.3.5 Hepatocellular cancer .20 -- 3.3.6 Locally recurrent rectal cancer 20 -- 3.3.7 Key points 20 -- 3.4 SAFETY 21 -- 3.4.1 Low-grade glioma .21 -- 3.4.2 Primary sinonasal tumours and recurrences of head & neck tumours .22 -- 3.4.3 Breast cancer 23 -- 3.4.4 Pancreatic cancer 24 -- 3.4.5 Hepatocellular cancer .25 -- 3.4.6 Locally recurrent rectal cancer 28 -- 3.4.7 Key points 28 -- 3.5 SECONDARY TUMOURS .29 -- 3.6 ONGOING TRIALS 29 -- 4 DISCUSSION .31 -- 4.1 SCARCE AND FLAWED EVIDENCE ON THE EFFECTIVENESS OF PROTON TREATMENT .31 -- 4.2 UNCERTAINTY ABOUT THE SAFETY OF PROTON TREATMENT .32 -- 4.3 FEW DATA ON SECONDARY TUMOURS .32 -- 4.4 SOME RCTS UNDERWAY, BUTNOT IN THE VERYNEAR FUTURE 33 -- 4.5 LIMITATIONS OF THIS REPORT 33 -- REFERENCES .3