EFFectiveness of Endometrial Cancer Treatment (EFFECT)

EFFECT (EFFectiveness of Endometrial Cancer Treatment): A study on the quality and effectiveness of the care for endometrial cancer in Belgium.

With 78.920 newly diagnosed cases in 2018, corpus uteri cancer (i.e. uterine cancer, cervix uteri excluded) is the fourth most common cancer in European women after breast, colorectal and lung cancer. Furthermore, it is also the most common gynecologic cancer, preceding ovarian and cervical cancer (Source: ECIS – European Cancer Information System; from https://ecis.jrc.ec.europa.eu, accessed on 02/03/2020). Approximately 1.400 new cases are diagnosed each year in Belgium1. Moreover, in most European countries, uterine cancer (UC) incidence is increasing. This is mainly attributable to an increase in the major risk group (i.e. post-menopausal women), which is due to the aging and growing of the population, but also to marked increases in the prevalence of risk factors, obesity being the most important one. However, in Belgium, an AAPC (“average annual percentage change”) of -1,6% is described in the age-standardized incidence rate for the period 2004-2017 (1).

Nevertheless, compared to the other two major cancers of the female genital tract (i.e. ovarian and cervical cancer), UC has received much less scientific interest and funding for decades. Consequently, the scientific evidence underlying the clinical practice guidelines that are currently used for the management of UC is rather limited. For instance, whereas surgery is the well-established cornerstone of the treatment, especially the role of lymphadenectomy is highly controversial, as well as the most appropriate adjuvant treatment strategy. This is mainly the case for those patients diagnosed with early-stage disease. This way, decision-making by healthcare professionals regarding the most optimal treatment strategy remains difficult. Consequently, the scientific literature indeed shows a high variability in clinical practices at all steps during the management of uterine cancer, resulting in a varying quality of care and suboptimal care in many patients, both internationally, as well as in Belgium. Therefore, one of the highest priorities for today’s UC patients is to ensure that every patient receives a uniform and optimal quality of care no matter which healthcare professional or hospital that is consulted, as this is every patients’ right. Various approaches have been proposed to improve the quality of oncological care. One such approach is to measure quality objectively by use of quality indicators, and to give feedback to healthcare professionals. This approach has already been shown to lead to potentially important quality improvements in the practices of healthcare professionals.

In this view, the EFFECT (EFFectiveness of Endometrial Cancer Treatment) project was initiated between the different stakeholders (i.e. the Anticancer Fund, VVOG, GGOFLB, ABRO-BVRO, BSMO, the pathologists, and the Belgian Cancer Registry (BCR)), and is now funded by Kom op tegen Kanker. EFFECT is a multicentric prospective observational registration project on uterine cancer with the objective to improve the quality of life and outcome of every UC patient diagnosed in Belgium by pursuing more uniformity and quality in the care for this disease. For this purpose, the quality of care and its interhospital variability will be measured objectively by use of 41 carefully selected and clinically relevant quality indicators, and feedback and benchmarking will be provided to all voluntarily participating centres. The project went online in February 2013, and extensive information on more than 4.200 UC patients diagnosed between 01/01/2012 and 31/12/2016 has already been gathered prospectively. Moreover, individual feedback and benchmarking has already been given once to the participating hospitals in 2015. Now, this PhD project is intended to further analyze the highly comprehensive and valuable information present in the EFFECT database.

As mentioned above, the ultimate objective of EFFECT is to make sure that every Belgian UC patient receives a uniform and optimal care. We expect to accomplish this objective by:

1) Providing the participating centres with an individual feedback report regarding their own results on each of the 41 quality indicators, in which they will also be able to benchmark their results to those of the other centers. This will hopefully result in the centers undertaking actions to improve the quality of those processes demonstrated to be suboptimal.

2) By addressing the following two research questions: (a) Does hospital volume (i.e. the annual number of UC patients that were treated in that hospital) have a significant impact on the quality and outcome of UC care in Belgium (volume-outcome analysis); (b) Have the quality and outcome of UC care increased on a national level since the beginning of the project (time-trend analysis).

Namely, the results of the first research question could potentially form an important incentive for the different stakeholders and policy makers to start a discussion on the potential need for a centralization of UC care in Belgium, in which UC patients may only be managed in those hospitals that, thanks to their high volume, have the necessary experience and resources to be able to provide an optimal and uniform care to every UC patient. Whereas, the results of the second research question will provide us insights on whether or not the voluntary participation of hospitals and healthcare professionals to a quality improvement project as EFFECT, and its methodology, actually has the potential to significantly improve the quality of care and outcome on a national level. Finally, it should also be noted that Belgium is a pioneer is measuring the quality of care for uterine cancer in Europe. Therefore, EFFECT could also have an impact well beyond Belgium, especially when successful.

References:

1.            Cancer burden in Belgium 2004-2017, Belgian Cancer Registry, Brussels, 2020.