Health Services Research (HSR) in oncology: end-of-life therapies

Supported by DexHelpp (data-requirements and -acquisition), Nicole Grössmann
Duration: January 2018 – March 2020
Publication: LBI-HTA Project report No. 127: http://eprints.aihta.at/1233

Background:
The broad spectrum of cancer care presents special challenges for quality measurement. Multimodal treatments (surgery, chemo-, hormone-, immune-, radiotherapy) are characterized by a repeated change between outpatient and inpatient treatment. Nevertheless, internationally generic indicators have been developed that measure the quality of care irrespective of the tumour entity [1, 2]. The most commonly used generic quality indicator relates to end-of-life care: Death in a bed in acute care, intensive care and systemic therapies in the last few weeks of life [3] is associated with negative quality of care. Recent analyses of routine data from Switzerland [4] or seven Western countries [5] show that in Belgium, Canada, England, Germany and Norway (38.3–52.1%) the proportion of those who died in hospitals was significantly higher than in the Netherlands and the USA (29.4% and 22.2%, respectively). An exploratory study with data from Lower Austria (NÖGKK) insured persons in this age group was 58.4%, which is above the highest international reference value (Canada 52.1%) [6].

Project aim and research question:
The project aims to extend the exploratory study on oncological therapies at the end-of-life from Lower Austria with data from all nine Federal States of Austria and at embedding the information about the place of death, hospital and intensive care admission at the end-of-life, and systemic (curative) therapies at the end-of-life in a literature synthesis on this topic. In addition, the possibility of operationalizing the generic indicators compiled by Patera and Wild (2012) [2] with routine data from the Austrian healthcare system will be examined. Building on this, it should be shown in which areas additional data needs exist.

Methods:
In addition to

1. Selective (hand) search for empirical studies on the care of oncological patients at the end-of- life
2. Analysis of routine data, and
3. Aggregated presentation of results.

Time management:

• January 2018–March 2019: Literature search and definition data-requirements, -acquisition
• April 2019–November 2019: Data-analysis
• December 2019–Jan 2020: Reporting, Peer-Review

Literature:

[1]    Patera, N. (2011): Behandlungsqualität in der Onkologie und deren Messung. HTA-Projektbericht 49a.

[2]    Patera, N. und Wild, C. (2012): Generische Indikatoren für Prozessqualität in der Onkologie: Ein Kompendium. HTA-Projektbericht 49b.

[3]    Wild, C., Patera, N., (2013) Measuring quality in cancer care: initiatives in seven countries. European Journal of Cancer Care 22 (6):  773–781.

[4]    Matter-Walstra KW, et al. (2014) Delivery of health care at the end of life in cancer patients of four swiss cantons: a retrospective database study (SAKK 89/09). BMC Cancer;14:306.

[5]    Bekelmann JE, Halpern SD, Blankart CR. (2016) Comparison of Site of Death, Health Care Utilization, and Hospital Expenditures for Patients Dying With Cancer in 7 Developed Countries. JAMA;315(3):272-83.

[6]     Fuchs F, Robausch M (2017) Vortrag bei HTA in KA, 28.9.2017, eingereicht als Manuskript.