RS: Ladies and gentlemen, a warm welcome to ecancer here at the World Cancer Congress. It’s absolutely marvellous to be joined by two colleagues from the Global Oncology Group at King’s College London, they’ve been doing some absolutely fascinating work on performance metrics that they’ve been discussing here at the congress. Let me introduce, first of all, and welcome nearly a doctor, nearly a doctor? Nearly a doctor, Megan McLeod who is a medical student at Vanderbilt, in the last year, I think, is it last year? Last year, and has just finished her Master’s at the London School of Economics. And a great colleague who has been working with us who is a senior oncology pharmacist and she’s been working on systemic anti-cancer performance metrics and we’re here to discuss performance metrics. Probably one of the least well understood areas of health services research, incredibly important. It really is the heart of quality assurance programmes for cancer centres, but, of course, it requires us to know what performance metrics are going to be actually important for centres in low- and middle-income countries. Both of you have been doing really exciting work. Megan, can I start with you? Tell us a little bit about the work you’ve been doing on performance metrics for surgery.
MM: Yes, as you said, quality metrics are really important to understand how cancer centres are performing. We know that there has been a lot of research that has been done in terms of how performance metrics are being developed but we wanted to see how performance metrics are being used and which ones are being used in practice to compare centres. So the review that I have been working on has been looking at quality indicators in surgical oncology, trying to identify what indicators are being used and how they are being used, whether when those metrics are comparing centres if the authors of those studies are actually feeding that information back to the centres so that they can have a chance to improve on their own quality or learn from one another potentially.
RS: And how difficult has it been? Give us a sense of the scale of the work because this is a huge amount of literature to have to wade through. So give me a sense of the scale of the work in surgical oncology.
MM: Sure. We were actually surprised to find a number of studies that were comparing things, mostly out of the US. We ended up including 82 studies total in this review which was much more than we initially expected. More than half were out of the US and the others were primarily from high-income countries, so a dearth of low-income countries contributing to these metrics, yes.
RS: So we’ll come back to that a bit later, actually, because I think that’s one of the issues is performance metrics which have been really developed by high-income countries for high-income countries and here we’re talking about, obviously, global oncology and performance metrics in very different resource settings. Kari, can I turn to you next, and maybe just the same question again – tell us a little bit about what you’ve been doing around systemic anti-cancer therapies and some of the findings.
KL: Very similar to Megan’s work, my work is looking at systemic therapy. We already know that this is an existing gap in the literature so we didn’t expect there to be many papers at all. In the end we included 15 papers in our review, all of which were high-income countries with one exception that was South Africa, a middle-income country. So there were actually no papers at all in low-income country settings.
RS: So that’s really important because we have a really big disparity here between the work that is being done in surgical oncology – over 80 papers here – and hardly any in systemic anti-cancer therapy, considering what a massive area it is for practice. Did that surprise you or were you expecting that?
KL: We did go into this review expecting that there wasn’t going to be many papers available, especially given many of these high-income countries, they have obviously more data sources to draw on to then develop these quality indicators. This is definitely a challenge that we can see if we had to use these same metrics in low- and middle-income countries.
RS: So that’s a really important point. Let’s just talk about the performance metrics, taking these, extracting these out of the papers, obviously. The next stage, which you’ve both been involved in, which is socialising them with experts around the world and the Delphi process of extracting what metrics might be useable. Megan, back to you, tell us a little bit now about what you’re doing with the performance metrics and validating them.
MM: So using both of the reviews that we’ve done, as well as a prior review that was done in radiotherapy, and in discussion with a small group of experts, we have put together a list of quality indicators in surgery and radiotherapy and chemotherapy to try to come up with a group of core indicators that we think all cancer centres should be able to measure and measure similarly. We want to be able to develop a list of indicators that are measurable and feasible in a lot of different settings. So we have put this list out to a number of different people who are working in low- and middle-income countries around the world to be able to hear their opinion on whether these measures are feasible and whether they believe that they are actually important and will measure quality in a meaningful way in these centres.
RS: This is obviously work we’re doing under the auspices of funding from the City Cancer Challenge, lots of other groups, though, very interested in the output – the American Society for Clinical Oncology, the World Health Organisation cancer team as well. We’re not going to spoil the surprise by telling anybody yet what the results are but they are absolutely fascinating. I think they provide a broad range of metrics from surgery, radiotherapy, through to systemic anti-cancer therapies. It’s really exciting work, I know you’ve both been publishing both these pieces of work and another piece of work downstream, I really look forward to seeing this. And thank you today for sharing your work with ecancer.
MM: Thank you.
KL: Thank you for having us.