Improving value for cancer patients: A European study of outcomes in practice

Abstract

Background: ICHOM(International Consortium for Health Outcomes measurement) and All.Can- an international multi-stakeholder initiative - are in partnership to identify and support a community of European hospitals to assess how they can optimize the efficiency of cancer care in breast and lung cancer patients. Methods: A community of 10 hospital sites for lung cancer and 10 for breast cancer will be supported to implement and measure the ICHOMstandard sets of outcomes. This community will measure clinical and patient reported outcomes and will use Time Driven Activity Based Costing to measure the cost to deliver cancer care. Guidance will also be provided to the community to support the utility of outcomes and cost data. The All.Can Patient Survey will also be deployed at the sites to obtain patient insights on sources of potential inefficiency in their care. Additional aspects of care, including intervention type and delivery of care, will also be measured based on results of an international literature review on determinants of value in the two indications. Outcome domains for collection for lung cancer patients include survival, complications, other outcomes such as treatment delays and quality of measures at the end of life. For breast cancer, the outcomes domains include survival and cancer control, disutility of care such as the impact of acute complications and degree of health. All data will be collected over a six-month period. Outcomes data will be collected on all patients with a first diagnosis of lung or breast cancer, followed up over a 6-month period, with three data collection points: (1) immediately after diagnosis, prior to treatment initiation; 3 months and 6 months after treatment initiation. Results: Risk adjusted outcomes and costing data for the lung and breast pathways will be compared to one another to identify variation and its potential drivers. Qualitative interviews and insights from the All.Can Patient Survey will be used to identify barriers and enablers to value measurement and innovative value improvement strategies. Conclusions: Findings will guide All.Can policy recommendations to improve the efficiency of cancer care.