A groundbreaking study released today in the June 9 Journal of the National Cancer Institute reports on a set of expert consensus-based quality indicators to evaluate pancreatic cancer care across the United States. The research team not only discerned noticeable variances in treatment outcomes, but they were also able to use these new quality indicators to evaluate and identify areas for improvement.

As there are no formal quality indicators already in place for this disease site, researchers from the American College of Surgeons' Pancreatic Cancer Quality Indicator Development Expert Panel set out to identify quality indicators from recognized sources including the medical literature, consensus guidelines, and interviews with experts. The researchers then called upon a panel of 20 pancreatic cancer experts to rank the validity of the quality indicators using a modification of the RAND/UCLA Appropriateness Methodology.

Once identified, the valid quality indicators were then used to evaluate performance on these indicators for patients diagnosed with pancreatic adenocarcinoma from January 1, 2004, to December 31, 2005, at 1,143 hospitals that contribute data to the National Cancer Database (NCDB) of the American College of Surgeons (ACS). Lead author Karl Bilimoria, MD, MS, and colleagues found a range of 49.6 percent to 97.2 percent for patient-level adherence to the quality indictors, and an even wider adherence rate of 6.7 percent to 99.9 percent at the hospital level. Moreover, the researchers found that most hospitals adhered to less than half of the 10 component quality indicators that were used to develop a composite score for the study.

In addition to Dr. Bilimoria--who led the study while he was an ACS Research Fellow and who is currently a surgical resident at the Feinberg School of Medicine, Northwestern University, Chicago--the research team included David J. Bentrem, MD, FACS (Northwestern University); Keith D. Lillemoe, MD, FACS (Indiana University School of Medicine); Mark S. Talamonti, MD, FACS (North Shore University Health System, Evanston, IL); and Clifford Y. Ko, MD, FACS (University of California at Los Angeles and VA Greater Los Angeles Healthcare System).

The American College of Surgeons Commission on Cancer (CoC) is a pioneer in measuring performance in the field of cancer care. All hospitals and free-standing cancer treatment facilities accredited by the CoC report clinical data through the National Cancer Data Base and receive evidence-based benchmark comparison reports based on accepted standards of care for breast and colorectal cancers, which are endorsed by the National Quality Forum.

The study was supported by the American College of Surgeons Clinical Scholars in Residence program and the Department of Surgery, Feinberg School of Medicine, Northwestern University.

CITATION

Article: Bilimoria et al. Assessment of Pancreatic Cancer Care in the United States Based on Formally Developed Quality Indicators. J Natl Cancer Inst 2009, 101:848-858.

Accompanying Editorial: Brennan M. Quality Pancreatic Cancer Care: It's Still Mostly About Volume. J Natl Cancer Inst 2009, 101:837-838.

About the National Cancer Data Base

The National Cancer Data Base--a joint program supported by the American College of Surgeons Commission on Cancer and the American Cancer Society--is recognized as the largest clinical registry in the world. It is a nationwide oncology outcomes database for more than 1,460 Commission on Cancer accredited cancer programs in the United States and Puerto Rico, and captures approximately 70 percent of all new invasive cancers diagnosed annually.