About the quality of medical care in oncology and “performance” in this medical field

Introduction

In an attempt to improve medical care in oncology and in the healthcare system in general, performance criteria are being sought which will also determine the future financing of hospital units that also have oncology departments. Things are complicated, and the implementation of a new system must be done, in my opinion, gradually, with pilot studies in advance.

Without resorting to studies carried out on this issue or to the recommendations of specialized calculations, we would believe that the number of patients treated is sufficient to assess the performance of a hospital or doctor. However, this would make us fall into the trap of the simplistic method, based on the number of drugs used, a term used by pharmaceutical companies that employ this criterion to build “personalities” regardless of the professional degree of the doctor. Unfortunately, this trap also works at “larger houses”, institutions that only take into account scores given by publications in journals from the “Thomson Reuters group”, a private group that has captured the “medical scientific market”. The pharmaceutical industry proposes studies, doctors introduce as many cases as possible into these studies, and the one who introduced the most cases becomes the main author of an article that will be published in a journal from the aforementioned group, an article that is not even written by that doctor who did not even participate in the design of the study. Therefore, where is the originality, creativity, intuition, etc.?

Through all these discussions, I do not want to diminish the importance of the articles that doctors should publish, research articles or articles that expose their own experience, articles that define the doctor’s personality, the power of observation, the quality of administering an adequate treatment, etc.

Performance indicators of medical act
in the specialty of medical oncology

Performance standards in cancer care re­fer to specific, measurable criteria used to evaluate the quality and effec­tive­­ness of cancer treatment and ma­nage­­ment. Standards in healthcare are de­signed to ensure that patients receive the highest level of care, from diagnosis through treat­ment.

Criteria of performance appreciation
in medical oncology

The criteria for performance appreciation in medical oncology encompass a range of factors that contribute to the quality and effectiveness of cancer care. These criteria include:

• Clinical expertise – demonstrating a high level of clinical knowledge and skill in diag­nosing and treating various cancers.
• Patient care quality – ensuring high standards of care and patient satisfaction through effective communication and collaboration.
• Contribution to research and clinical trials – engaging in clinical trials or re­search initiatives to advance oncology care.
• Continuous learning – committing to ongoing education and staying updated with the latest medical advancements.
• Multidisciplinary collaboration – working effectively with other healthcare professionals to develop comprehensive treatment plans.
• Mentoring and development – supporting junior staff or medical students in their professional growth and development.

These criteria are essential for evaluating the performance of medical oncologists and for ensuring they meet the high standards expected in the field⁽¹⁾.

These evaluation criteria must be developed following evidence recognized by international oncology societies, such as ASCO and ESMO.

Oncology performance metric criteria

The criteria for establishing oncology performance metrics are multifaceted and aim to ensure high-quality care. Key considerations include:

• Importance – metrics should be deemed important based on evidence and their potential to improve patient outcomes.
• Supporting evidence – metrics should be supported by robust evidence from clinical trials or other reliable sources.
• Opportunity for improvement – metrics should offer opportunities for improvement in care delivery.
• Ease of measurement – metrics should be feasible to measure and extract using available and reliable data.

These criteria guide the development of quality measures within the Merit-based Incentive Payment System (MIPS) and other healthcare payment models. The NCCN Quality and Outcomes Committee plays a crucial role in reevaluating existing measures and proposing new concepts to fill the gaps in cancer care quality measurement⁽²⁾.

The American Society of Clinical Oncology (ASCO) recognizes the importance of curtailing aggressive care at the end-of-life period for patients diagnosed with cancer. Unfortunately, studies have suggested that, over time, cancer care is becoming more aggressive, especially near the end-of-life period. Intensive care unit (ICU) admissions are often deemed as an indicator of “aggressive care”, and are typically used to gauge the quality of care provided to late-stage cancer patients. ASCO advocates for early integration palliative care/hospice services for patients with late-stage cancer in order to avoid aggressive measures at the end of life. With this measure, ASCO hopes providers can evaluate internal processes and make the necessary changes through quality improvement initiatives to ultimately improve a patient’s death experience and improve patient and caregiver/family satisfaction. Additionally, the reduction of ICU admissions at the end of life should reduce overall unnecessary resource utilization costs⁽⁴⁾.

Conclusions

The criteria for the appreciation of activity of medical oncology and department are very complex and include domains such as clinical productivity, adherence to evidence-based guidelines, patient outcomes, safety metrics, research and academic activity, patient experience and resource utilization. These principles are reflected in international oncology quality initiatives, professional society guidelines, and health system accreditation standards.

“Medical oncology has become a complex discipline with a multidisciplinary dimension. Many other disciplines are involved in patient care and treatment, which may influence certain quality aspects of this care (e.g., preparation of medication by the pharmacists, administration of the medication by the nursing department, psychosocial support of the patients and family by the psychologist and social  worker, spiritual support or patient education related to oral drugs). It is necessary that medical oncologists evaluate the performance of their departments in relation to cancer care and treatment of this multidisciplinary team and, if necessary, improve their practices”⁽⁵⁾.