Defining current gaps in quality measures for cancer immunotherapy: consensus report from the Society for Immunotherapy of Cancer (SITC) 2019 Quality Summit

Abstract

BackgroundQuality measures are important because they can help improve and standardize the delivery of cancer care among healthcare providers and across tumor types. In an environment characterized by a rapidly shifting immunotherapeutic landscape and lack of associated long-term outcome data, defining quality measures for cancer immunotherapy is a high priority yet fraught with many challenges.MethodsThus, the Society for Immunotherapy of Cancer convened a multistakeholder expert panel to,first, identify the current gaps in measures of quality cancer care delivery as it relates to immunotherapy and to,second, advance priority concepts surrounding quality measures that could be developed and broadly adopted by the field.ResultsAfter reviewing the existing quality measure landscape employed for immunotherapeutic-based cancer care, the expert panel identified four relevant National Quality Strategy domains (patient safety, person and family-centered care, care coordination and communication, appropriate treatment selection) with significant gaps in immunotherapy-based quality cancer care delivery. Furthermore, these domains offer opportunities for the development of quality measures as they relate to cancer immunotherapy. These four quality measure concepts are presented in this consensus statement.ConclusionsThis work represents a first step toward defining and standardizing quality delivery of cancer immunotherapy in order to realize its optimal application and benefit for patients.

Measurement that matters: A systematic review and modified Delphi of multidisciplinary colorectal cancer quality indicators

“…There are ongoing advances in the various treatment modalities available with rapidly evolving evidence pertaining to their use. Therefore, good communication, collaboration, and coordination among MDT members are needed 6,8,9 . To ensure consistent delivery of high‐quality care, it is important to measure and monitor the delivery of care by MDTs to identify any unwarranted variations 10 …”

“…Therefore, good communication, collaboration, and coordination among MDT members are needed. 6,8,9 To ensure consistent delivery of high-quality care, it is important to measure and monitor the delivery of care by MDTs to identify any unwarranted variations. 10 An important tool for monitoring care delivery and patient outcomes is a set of clinically relevant, evidence-based quality indicators (QIs).…”

“…10 An important tool for monitoring care delivery and patient outcomes is a set of clinically relevant, evidence-based quality indicators (QIs). 9,11 QIs are measurable elements of practice performance supported by evidence for assessing the quality of care. 12 They can be categorized as structure, process, and outcome measures.…”

“…15 Defining QIs in a tumor stream can facilitate the creation of benchmarks for standardization of care across healthcare services. 9 QI development can be evidence-based and derived from scientific literature or, when scientific evidence is lacking, determined by an expert panel of HPs in a consensus process. 16 Ideally, a QI is both selected from research data and supplemented by expert opinion.…”

The role and economics of immunotherapy in solid tumour management

“…Given that even with the historical $50,000/QALY cited in the literature then only three of the twenty economic studies used in a 2018 systematic analyses of immunotherapies would demonstrate cost effectiveness. 23,24 Importantly however with identification of suitable biomarkers and therefore improved patient selection, it can be deduced that QALY and ICER measures will decrease markedly while providing maximal clinical benefit. In conclusion while immunotherapy offers to otherwise terminal patients a chance of robust durable responses it is associated with both high treatment costs and frequency of expensive adverse side effects which may limit its use.…”