Measuring variation in the quality of systemic anti-cancer therapy delivery across hospitals: A national population- based evaluation

Aim: To date, there has been little systematic assessment of the quality of care associated with systemic anti-cancer therapy (SACT) delivery across national healthcare sys-tems. We evaluated hospital-level toxicity rates during SACT treatment as a means of identi-fying variation in care quality.Methods: All colorectal cancer (CRC) patients receiving SACT within 106 English National Health Service (NHS) hospitals between 2016 and 2019 were included. Severe acute toxicity rates were derived from hospital administrative data using a validated coding framework. Variation in hospital-level toxicity rates was assessed separately in the adjuvant and metastatic settings. Toxicity rates were adjusted for age, sex, comorbidity, per-formance status, tumour site, and TNM staging.Results: Eight thousand one hundred and seventy three patients received SACT in the adju-vant setting, and 7,683 patients in the metastatic setting. Adjusted severe acute toxicity rates varied between hospitals from 11% to 49% for the adjuvant cohort, and from 25% to 67% for the metastatic cohort.Compared to the national mean toxicity rate in the adjuvant cohort, six hospitals were more than two standard deviations (2SD) above, and four hospitals were more than 2SD below. In the metastatic cohort, six hospitals were more than 2SD above, and seven hospitals were more than 2SD below the national mean toxicity rate.Overall, 12 hospitals (12%) had toxicity rates more than 2SD above the national mean, and 11 (10%) had rates more than 2SD below. Conclusion: There is substantial variation in hospital-level severe acute toxicity rates in both the adjuvant and metastatic settings, despite risk-adjustment. Ongoing reporting of this per-formance indicator can be used to focus further investigation of toxicity rates and stimulate quality improvement initiatives to improve care. 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Automated summary

This study evaluated hospital-level toxicity rates during systemic anti-cancer therapy (SACT) delivery in national healthcare systems and found significant variation in care quality. The results showed substantial differences in toxicity rates between hospitals in both adjuvant and metastatic settings, despite risk-adjustment. Consequently, ongoing monitoring and reporting of this performance indicator can contribute to improving the quality of care.