Skip to main content
SpringerLink
Log in

Assessing Quality of Care for the Myelodysplastic Syndromes

  • Myelodysplastic Syndromes (D Steensma, Section Editor)
  • Published:
Current Hematologic Malignancy Reports Aims and scope Submit manuscript

Abstract

Measuring the quality of care for patients with chronic cancers is difficult, especially for heterogeneous malignancies such as the myelodysplastic syndromes (MDS). Recent work suggests that improvements may be needed in the quality of diagnostic, treatment, and end-of-life care for patients with these syndromes. Moreover, rigorous assessment of factors that are necessary to deliver high-quality care such as preferred method of decision-making and pre-treatment quality of life are often overlooked. Finally, a key component of quality care is that it is received equitably across different patient populations, yet several recent studies suggest that there are financial, educational, race-ethnic, and age-related barriers to equitable MDS care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, are highlighted as: • Of importance

  1. DeMartino JK. Measuring quality in oncology: challenges and opportunities. J Natl Compr Cancer Netw. 2013;11(12):1482–91.

    Google Scholar 

  2. Institute of Medicine. Crossing the quality chasm: a new health system for the 21th century. IOM. 2001.

  3. Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q. 1966;44(3):166–206.

    Article  Google Scholar 

  4. Donabedian A. The quality of care: how can it be assessed? JAMA. 1988;260(12):1743–8.

    Article  CAS  PubMed  Google Scholar 

  5. Adess L, Itzykson R, Fenaux P. Myelodysplastic syndromes. Lancet. 2014;383:2239–52.

    Article  Google Scholar 

  6. Tefferi A, Vardiman JW. Myelodysplastic syndromes. NEJM. 2009;361:1872–85.

    Article  CAS  PubMed  Google Scholar 

  7. Vardiman JW, Thiele J, Arber DA, Brunning RD, Borowitz MJ, Porwit A, et al. The 2008 revision of the WHO classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood. 2009;114(5):937–52.

    Article  CAS  PubMed  Google Scholar 

  8. Abel GA, Van Bennekom CM, Stone RM, Anderson TE, Kaufman DW. Classification of the myelodysplastic syndrome in a national registry of recently diagnosed patients. Leuk Res. 2010;34(7):939–41.

    Article  PubMed  Google Scholar 

  9. Balleari E, Salvetti C, Del Corso L, Filiberti R, Bacigalupo A, Bellodi A, et al. Age and comorbidities deeply impact on clinical outcome of patients with myelodysplastic syndromes. Leuk Res. 2015;39(8):846–52.

    Article  CAS  PubMed  Google Scholar 

  10. Neukirchen J, Nachtkamp K, Schemenau J, Aul C, Giagounidis A, Strupp C, et al. Change of prognosis of patients with myelodysplastic syndromes during the last 30 years. Leuk Res. 2015;39(7):679–83.

    Article  PubMed  Google Scholar 

  11. National Quality Forum. Cancer measures endorsement summary. 2012.

    Google Scholar 

  12. Greenberg PL, Sun Z, Miller KB, Bennett JM, Tallman MS, Dewald G, et al. Treatment of myelodysplastic syndrome patients with erythropoietin with or without granulocyte colony-stimulating factor : results of a prospective randomized phase 3 trial by the Eastern Cooperative Oncology Group (E1996). Blood. 2009;114(12):2393–400.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Greenberg PL, Cosler LE, Ferro SA, Lyman GH. The costs of drugs used to treat myelodysplastic syndromes following national comprehensive cancer network guidelines. J Natl Compr Cancer Netw. 2008;6(9):942–53.

    Google Scholar 

  14. Nissenson AR. Hyporesponsiveness to erythropoietin: overview, 1996. Perit Dial Int. 1996;16(13):417–20.

    CAS  PubMed  Google Scholar 

  15. Abel GA, Cronin AM, Odejide OO, Uno H, Stone RM, Steensma DP. Influence of Patient and Provider Characteristics on Quality of Care for the Myelodysplastic Syndromes. BJH. 2016;in press. The authors found suboptimal rates of adherence to two accepted MDS quality standards: marrow cytogenetic testing (found to be 74% of patients) and pre-erythropoietin therapy iron assessment (found to be 56% of patients).

  16. Davidoff AJ, Weiss SR, Baer MR, Ke X, Hendrick F, Zeidan A, et al. Patterns of erythropoiesis-stimulating agent use among Medicare beneficiaries with myelodysplastic syndromes and consistency with clinical guidelines. Leuk Res. 2013;37(6):675–80. The authors found low rates of adherence to NCCN guidelines for erythropoietin therapy in MDS such as (1) it should be administered to low-risk patients for a minimum of 8 weeks and (2) serum erythropoietin levels should be measured prior to initiating therapy.

    Article  PubMed  PubMed Central  Google Scholar 

  17. CMS. Computation of the 2016 Value Modifier Fact Sheet. Centers Medicare Medicaid Serv. 2015.

  18. CMS. Detailed Methodology for the 2016 Value Modifier and the 2014 Quality and Resource Use Report. Centers Medicare Medicaid Serv. 2015.

  19. NCCN. Myelodysplastic syndromes. NCCN Clin Pract Guidel Oncol. 2016;Version 1.

  20. Sekeres MA, Stowell SA, Berry CA, Mencia WM, Dancy JN. Improving the diagnosis and treatment of patients with myelodysplastic syndromes through a performance improvement initiative. Leuk Res. 2013;37(4):422–6.

    Article  PubMed  Google Scholar 

  21. Burwell SM. Setting value-based payment goals—HHS efforts to improve U.S. health care. N Engl J Med. 2015;372(10):897–9.

    Article  CAS  PubMed  Google Scholar 

  22. Odejide OO, Cronin AM, Earle CC, Lacasce AS, Abel GA. Hospice use among patients with lymphoma: impact of disease aggressiveness and curability. J Natl Cancer Inst. 2016;108(1):1–8.

    Article  Google Scholar 

  23. Earle CC, Landrum MB, Souza JM, Neville BA, Weeks JC, Ayanian JZ. Aggressiveness of cancer care near the end of life: is it a quality-of-care issue? J Clin Oncol. 2008;26(23):3860–6.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hui D, Didwaniya N, Vidal M, Shin SH, Chisholm G, Roquemore J, et al. Quality of end-of-life care in patients with hematologic malignancies: a retrospective cohort study. Cancer. 2014;120(10):1572–8.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Fletcher SA, Cronin AM, Zeidan AM, Odejide OO, Gore SD, Davidoff AJ, et al. Intensity of end-of-life care for patients with myelodysplastic syndromes: findings from a Large National Database. Cancer. 2016; in press. The investigators assessed the quality of MDS end-of-life care via traditional quality measures: admission to the ICU in the last month of life (28%) and enrollment in hospice care (49%). They concluded that EOL care for patients with MDS was potentially suboptimal.

  26. Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen MLG, Extermann M, et al. International society of geriatric oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol. 2014;32(24):2595–603.

    Article  PubMed  PubMed Central  Google Scholar 

  27. NCCN. Older adult oncology. NCCN Clin Pract Guidel Oncol. 2016.

  28. Buckstein R, Wells RA, Zhu N, Leitch HA, Nevill TJ, Yee KWL, et al. Patient-related factors independently impact overall survival in patients with myelodysplastic syndromes: an MDS-CAN prospective study. Br J Haematol. 2016;epub ahead:1–14.

  29. Caocci G, Voso MT, Angelucci E, Stauder R, Cottone F, Abel G, et al. Accuracy of physician assessment of treatment preferences and health status in elderly patients with higher-risk myelodysplastic syndromes. Leuk Res. 2015;39(8):859–65. The authors found that physicians’ beliefs about the decision-making style of their patients (active, collaborative or passive) was only concordant with patients’ self-reported style in half (49%) of cases. Physicians also overestimated their patients self-reported QOL. This is potentially suboptimal with respect to quality patient-centered care.

    Article  CAS  PubMed  Google Scholar 

  30. Efficace F, Gaidano G, Breccia M, Voso MT, Cottone F, Angelucci E, et al. Prognostic value of self-reported fatigue on overall survival in patients with myelodysplastic syndromes: a multicentre, prospective, observational, cohort study. Lancet Oncol. 2015;16:1506–14. The authors found that for patients with MDS, higher fatigue scores were independently associated with poorer overall survival, even when controlling for disease risk.

    Article  PubMed  Google Scholar 

  31. Gotay C. Fatigue and mortality: from description to action. Lancet Oncol. 2015;2045(15):15–6.

    Google Scholar 

  32. Smith AR, Warlick ED, Roesler MA, Poynter JN, Richardson M, Nguyen P, et al. Factors associated with hematopoietic cell transplantation (HCT) among patients in a population-based study of myelodysplastic syndrome (MDS) in Minnesota. Ann Hematol. 2015;94(10):1667–75. The authors reported factors associated with hematopoietic stem cell transplantation in MDS, finding that higher-income and more highly educated patients were more likely to undergo transplantation. This finding may represent inequitable and lower-quality care.

  33. Pease DF, Ross JA, Poynter JN, Nguyen PL, Hirsch B, Cioc A, et al. Differences in community and academic practice patterns for newly diagnosed myelodysplastic syndromes (MDS) patients. Cancer Epidemiol. 2015;39(2):222–8.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Jha AK, Joynt KE, Orav EJ, Epstein AM. The long-term effect of premier pay for performance on patient outcomes. N Engl J Med. 2012;366(17):1607–15.

    Article  Google Scholar 

  35. Petersen LA. Effects of individual physician-level and practice-level financial incentives on hypertension care. JAMA. 2013;310(10):1042–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Scott A, Sivey P, Ait Ouakrim D, Willenberg L, Naccarella L, Furler J, et al. The effect of financial incentives on the quality of health care provided by primary care physicians. Cochrane Database Syst Rev. 2011;7(9):CD008451.

  37. Dolor RJ, Schulman KA. Financial incentives in primary care practice: the struggle to achieve population health goals. JAMA. 2013;310(10):1031–2.

    Article  CAS  PubMed  Google Scholar 

  38. Zon RT, Frame JN, Neuss MN, Page RD, Wollins DS, Stranne S, et al. American Society of Clinical Oncology Policy Statement on Clinical Pathways in Oncology. J Oncol Pract. 2016;epub ahead.

  39. Jacobson J. Physicians as champions for quality improvement. ASCO Post. 2016.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Brigham and Women’s Hospital, Boston, USA

    Zachary A. K. Frosch

  2. Division of Population Sciences and Center for Leukemia, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA

    Gregory A. Abel

Authors
  1. Zachary A. K. Frosch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gregory A. Abel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gregory A. Abel.

Ethics declarations

Conflict of Interest

Zachary A. K. Frosch and Gregory A. Abel each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Myelodysplastic Syndromes

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Frosch, Z.A.K., Abel, G.A. Assessing Quality of Care for the Myelodysplastic Syndromes. Curr Hematol Malig Rep 11, 402–407 (2016). https://doi.org/10.1007/s11899-016-0343-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11899-016-0343-0

Keywords

Search

Navigation