A National Cancer Database and Cancer Care Quality Improvement

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Lawrence N. Shulman, MD

Approximately 70% of newly diagnosed cancer patients have their records in the [National Cancer Data Base]. We currently have about 30 million records from hospital cancer registries across the country.

—Lawrence N. Shulman, MD

At this year’s Quality Care Symposium, Lawrence N. Shulman, MD, Chief of Staff and Director of the Center for Global Cancer Medicine at Dana-Farber Cancer Institute, Boston, looked at the issue of quality infrastructure development through the prism of several tools developed by the American College of Surgeons’ Commission on Cancer. Dr. Shulman is one of two ASCO representatives to that consortium and Chair of the Commission on Cancer’s Quality Committee.

“The Commission on Cancer was established by the American College of Surgeons in 1922, at a time when surgery was the only available cancer treatment. It is a now a broad-based consortium of professional organizations dedicated to improving survival and quality of life for cancer patients in hospitals. There are currently about 1,500 U.S. hospitals that are accredited by the Commission,” said Dr. Shulman.

Dr. Shulman explained that the National Cancer Data Base was formed in 1988 as a joint venture of the American College of Surgeons and the American Cancer Society. “Approximately 70% of newly diagnosed cancer patients have their records in the [National Cancer Data Base]. We currently have about 30 million records from hospital cancer registries across the country,” said Dr. Shulman.

Web-Based Tools

He then described the Rapid Quality Reporting System (RQRS), a fairly new Web-based data collection tool from the National Cancer Data Base. “All case information reported to the system is collected by cancer registries at participating programs and entered into their registry database. The system makes it easier for us to deliver evidence-based care in real clinical time. We do case tracking and ongoing reporting of quality metrics,” said Dr. Shulman.

“Another important component of the reporting system is that we can give feedback to clinicians if their patients have not had their recommended treatment in the appropriate time frame,” he continued. “So, if you have a patient who has had breast-conserving surgery, and after a certain period of time—I believe it should be about 180 days—she hasn’t received breast radiation therapy, the system pings the cancer program about the need for the treatment,” said Dr. Shulman. He added, “This is a voluntary program, and about 900 of the 1,500 hospital programs are participating in the RQRS. We feel that within a year or two, all hospital programs will be enrolled.”

Another Web-based tool is the Cancer Program Practice Profile Report, which hospitals can use to measure their compliance rates in a number of different quality metrics in the treatment of breast, colon, and rectal cancers. “This tool helps cancer programs gauge their intrafacility trends over time and compare the results to other facilities. It empowers clinicians, administrators, and other hospital staff to work cooperatively and diminish care disparities,” noted Dr. Shulman.

Other Initiatives

Dr. Shulman discussed another benefit of being a College of Surgeons’ accredited institution. “The Participant User File Research Program allows external researchers from any of the 1,500 member hospitals to conduct outcomes research utilizing the 30 million cancer patient records in the [National Cancer Data Base]. It’s a relatively easy three-page application for research data. In 2014, we received 227 applications and approved 194. The main reason for not approving a submission is that the data they were requesting didn’t exist.”

Dr. Shulman then discussed the very important initiative, the Cancer Quality Improvement Program, which was launched in 2013, and the first reports were delivered in February 2014. “We’re currently preparing the 2014 report and we hope to deliver them to the [Commission on Cancer] institutions by the end of the calendar year. This program is a data-driven, process and outcomes-based quality improvement program that generates individual facility level quality reports with a side-by-side comparison to other [Commission on Cancer] hospitals,” said Dr. Shulman.

He explained that the annual reports are in PowerPoint format that analyzes patient demographics, quality measures, survival data, and patients’ migration into and out of the system. “We think the target audience for these reports includes the hospital’s cancer committee, the individual oncologists, and the hospital’s executives and administration. So this data tool has value across the full spectrum of the hospital,” said Dr. Shulman.

Report Features

In the 2014 report, there will be data on 12 quality metrics. “Before we develop quality measures, we look into the [National Cancer Data Base] to identify the most important initiatives we should approach. For instance, one of the new measures is to have at least 10 regional lymph nodes removed and pathologically examined for staging IA, IB, IIA, and IIB resected non–small cell lung cancer. In 2012, the baseline adherence to this measure was only 39%, so there’s a lot of room for quality improvement there,” commented Dr. Shulman.

The report shows the individual hospital’s performance rate in each disease and also against the state, the region, and all Commission on Cancer programs, giving hospital leaders and doctors a good overall picture of their performance rate. “We’re also looking at survival data, both risk-adjusted and unadjusted. Beginning with breast, colon, and lung disease sites, these stage-specific data will be adjusted for age, race, gender, insurance status, and comorbidities,” explained Dr. Shulman.

Dr. Shulman noted that the program automatically produces reports on a yearly basis, so no chart abstractions are required, and it includes all cases from the participating institution. Moreover, there are a growing number of quality metrics being ­developed.

“There are a couple of disadvantages to the system. For example, specific systemic drugs are not included in the report and the information on tumor biomarkers is not yet complete,” said Dr. Shulman, adding, “The [Commission on Cancer] is dedicated to improving quality of life for patients through evidence-based care, and these tools that I’ve been discussing are an integral part of that effort.” ■

Disclosure: Dr. Shulman reported no potential conflicts of interest.


National Cancer Database and the Cancer Quality Improvement Program for the Commission On Cancer. Shulman LN: . Quality Care Symposium. Presented October 18, 2014.