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Quality indicators in neuro-oncology: Review of the literature and development of a new quality indicator set for glioma care through a two-round Delphi survey

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Abstract

Background

Quality Indicators (QIs) are important tools to assess the quality and variability of oncological care. However, their application in neuro-oncology is limited so far. The objective of this study was to develop a set of QIs for glioma, covering process and outcome indicators.

Methods

A systematic review was conducted to identify both QIs in the field of adult glioma care, and guidelines or recommendations that could be translated into QIs. Also reports from national and international healthcare agencies and scientific associations (“grey literature”) were taken into account. After conversion of these recommendations into QIs, merging with existing QIs found in the literature and rationalization, a two-round Delphi survey was conducted to gain consensus on relevance for the proposed QIs.

Results

In total 240 recommendations and 30 QIs were retrieved from the literature. After conversion, merging and rationalization, 147 QIs were evaluated in the Delphi survey and eventually consensus was gained on 47 QIs in the following 7 domains: Diagnosis and Imaging, Surgery, Pathology, Radio/Chemotherapy, Recurrence, Supportive Treatments (Epilepsy, Thromboembolism, Steroid Use and Rehabilitation) and Survival.

Conclusion

This study defined a set of 47 QIs for assessing quality of care in adult glioma patients, distributed amongst 7 crucial phases in the patient’s care trajectory. These QIs are readily applicable for use in diverse health care systems, depending on the availability of population-based health care data enabling (inter)national benchmarking.

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Data Availability

The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request. A summary of the data is included in the appendices.

Abbreviations

AAN:

American Academy of Neurology

AHRQ:

Agency for Healthcare Research and Quality

5-ALA:

5 amino-levulinic-acid

EANO:

European Association of Neuro-Oncology

ICU:

Intensive Care Unit

IDH:

Isocitrate dehydrogenase

KPS:

Karnofsky performance scale

MGMT:

O (6)Methylguanine-DNA methyltransferase

MRI:

Magnetic Resonance Imaging

NCCN:

National Comprehensive Cancer Network

NGS:

Next Generation Sequencing

NICE:

National Institute for Health and Care Excellence

NQF:

National Quality Forum

pMGMT:

O (6)Methylguanine-DNA methyltransferase gene promotor

SNO:

Society for Neuro-Oncology

PET:

Positron Emission Tomography

QI(s):

Quality Indicator(s)

QPI:

Quality Performance Indicator

WHO:

World Health Organisation

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Acknowledgements

We would like to thank all members of the QINO consortium taking part in the Delphi process for their time and efforts: Steven De Vleeschouwer, Frank Weyns, Florence Lefranc, Ludo Vanopdenbosch, Alex Michotte, Tom Boterberg, Nick Liefhooghe, Martin Lammens, Paul Clement, Nicolas Whenham,  Bart Neyns, Ann Tieleman, Serge Goldman, Ingeborg Goethals and Harlinde De Schutter. We are also very grateful to the following colleagues and friends for their help and support: Piet Mortelé, Johan Hellings, Lieven Wostyn, Patrick Linden, Lorenzo Staelens, Siska Dedeurwaerdere, Joris De Medts, Jeroen Van Lerbeirghe and Olivier Van Damme.

Collaborators for the QINO consortium

Steven De Vleeschouwer (Department of Neurosurgery, UZ Leuven, Leuven, Belgium and Research Group Experimental Neurosurgery and Neuroanatomy, Leuven Brain Institute (LBI) KU Leuven, Leuven, Belgium); Frank Weyns (Department of Neurosurgery, East Limburg Hospital, Genk, Belgium); Florence Lefranc (Service de Neurochirurgie, hôpital Erasme Université Libre de Bruxelles, Brussels, Belgium); Ludo Vanopdenbosch (Department of Neurology, Hospital AZ Sint-Jan, Bruges, Belgium); Alex Michotte (Department of Pathology, UZ Brussels, Brussels, Belgium and Center for Neuroscience, VUB, Brussels, Belgium); Tom Boterberg (Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium); Nick Liefhooghe (Department of Radiation Oncology, AZ Groeninge, Kortrijk, Belgium); Martin Lammens (Department of Pathology, Antwerp University Hospital, Edegem, Belgium); Paul Clement (Department of Oncology, UZ Leuven, Leuven Cancer Institute, Leuven, Belgium); Nicolas Whenham (Department of Medical Oncology, Cliniques Universitaires Saint-Luc, Brussels, Belgium and Department of Medical Oncology, Clinique Saint-Pierre, Ottignies, Belgium); Bart Neyns (Department of Medical Oncology, UZ Brussels, Brussels, Belgium);  Ann Tieleman (Department of Radiology, AZ Delta hospital, Roeselare, Belgium; Serge Goldman (Department of Nuclear Medicine, hôpital Erasme Université Libre de Bruxelles, Brussels, Belgium); Ingeborg Goethals (Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium); Harlinde De Schutter (Belgian Cancer Registry, Research Department, Brussels, Belgium);

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, AZ Delta Hospital Roeselare, Deltalaan 1, 8800, Roeselare, Belgium

    Dimitri Vanhauwaert & Stephanie Du Four

  2. Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium

    Harry Pinson

  3. Department of Radiation Oncology, AZ Delta, Roeselare, Belgium

    Caroline Sweldens

  4. Research Department, Belgian Cancer Registry, Brussels, Belgium

    Liesbet Van Eycken & Harlinde De Schutter

  5. Department of Neurosurgery, UZ Leuven, Leuven, Belgium

    Steven De Vleeschouwer

  6. Research Group Experimental Neurosurgery and Neuroanatomy, Leuven Brain Institute (LBI) KU Leuven, Leuven, Belgium

    Steven De Vleeschouwer

  7. Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium

    Tom Boterberg

Authors
  1. Dimitri Vanhauwaert
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  2. Harry Pinson
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  4. Stephanie Du Four
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  7. Steven De Vleeschouwer
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  8. Tom Boterberg
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Consortia

QINO consortium

  • Steven De Vleeschouwer
  • , Frank Weyns
  • , Florence Lefranc
  • , Ludo Vanopdenbosch
  • , Alex Michotte
  • , Tom Boterberg
  • , Nick Liefhooghe
  • , Martin Lammens
  • , Paul Clement
  • , Nicolas Whenham
  • , Bart Nyens
  • , Ann Tieleman
  • , Serge Goldman
  • , Ingeborg Goethals
  •  & Harlinde De Schutter

Contributions

DV: Conceptualization; Data curation; Formal analysis; Methodology; Project administration; Visualization; Writing—original draft; Writing—review & editing. HP: Data curation; Formal analysis; Writing—review & editing. CS: Writing—review & editing. SDF: Writing—review & editing. LVE: Conceptualization, Methodology; Project administration. HDS: Conceptualization; Methodology; Supervision; Validation; Writing—review & editing. SDV: Supervision; Validation; Writing—review & editing. TB: Supervision; Validation; Writing—review & editing.

Corresponding author

Correspondence to Dimitri Vanhauwaert.

Ethics declarations

Conflict of interest

SDV is a certified Gliolan (Medac GmbH) Trainer and has performed consultancy for Lamepro NV (Gliolan) for which a fee was received. All other authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was approved by the Ethics Committee of Ghent University Hospital.

Consent to participate

Not applicable.

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Not applicable.

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Collaborators of the QINO consortium are listed in “Acknowledgment”.

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Vanhauwaert, D., Pinson, H., Sweldens, C. et al. Quality indicators in neuro-oncology: Review of the literature and development of a new quality indicator set for glioma care through a two-round Delphi survey. J Neurooncol 157, 365–376 (2022). https://doi.org/10.1007/s11060-022-03971-3

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  • DOI: https://doi.org/10.1007/s11060-022-03971-3

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