Implementation of Quality Indicators for Vulvar Cancer in Gynaecological Cancer Centres Certified by the German Cancer Society (DKG)

Overview

Journal J Cancer Res Clin Oncol

Specialty Oncology

Date 2024 May 10

PMID 38727842

Authors

Frederik A Stuebs

Matthias W Beckmann

Christian Dannecker

Markus Follmann

Monika Nothacker

Hans-Georg Schnurch

Linn Woelber

Simone Wesselmann

Affiliations

Soon will be listed here.

Abstract

Purpose: In 2018, the first guideline-based quality indicators (QI) for vulvar cancer were implemented in the data-sheets of certified gynaecological cancer centres. The certification process includes guideline-based QIs as a fundamental component. These indicators are specifically designed to evaluate the level of care provided within the centres. This article aims to give an overview of the developing process of guideline based-QIs for women with vulvar cancer and presents the QIs results from the certified gynaecological cancer centres.

Methods: The QIs were derived in a standardized multiple step process during the update of the 2015 S2k guideline "Diagnosis, Therapy, and Follow-Up Care of Vulvar Cancer and its Precursors" (registry-number: no. 015/059) and are based on strong recommendations.

Results: In total, there are eight guideline-based QIs for vulvar cancer. Four QIs are part of the certification process. In the treatment year 2021, 2.466 cases of vulvar cancer were treated in 177 centres. The target values in the centres for pathology reports on tumour resection and lymphadenectomy as well as sentinel lymph nodes have increased since the beginning of the certification process and have been above 90% over the past three treatment years (2019-2021).

Discussion: QIs based on strong guideline recommendations, play a crucial role in measuring and allowing to quantify essential aspects of patient care. By utilizing QIs, centres are able to identify areas for process optimization and draw informed conclusions. Over the years the quality of treatment of vulvar cancer patients measured by the QIs was improved. The certification system is continuously reviewed to enhance patient care even further by using the outcomes from QIs revaluation.

References

Abu-Rustum N, Yashar C, Arend R, Barber E, Bradley K, Brooks R . Vulvar Cancer, Version 3.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2024; 22(2):117-135. DOI: 10.6004/jnccn.2024.0013. View

Becker M, Breuing J, Nothacker M, Deckert S, Steudtner M, Schmitt J . Guideline-based quality indicators-a systematic comparison of German and international clinical practice guidelines: protocol for a systematic review. Syst Rev. 2018; 7(1):5. PMC: 5767020. DOI: 10.1186/s13643-017-0669-2. View

Beckmann M, Brucker C, Hanf V, Rauh C, Bani M, Knob S . Quality assured health care in certified breast centers and improvement of the prognosis of breast cancer patients. Onkologie. 2011; 34(7):362-7. DOI: 10.1159/000329601. View

Beckmann M, Quaas J, Bischofberger A, Kammerle A, Lux M, Wesselmann S . Establishment of the Certification System "Gynaecological Dysplasia" in Germany. Geburtshilfe Frauenheilkd. 2014; 74(9):860-867. PMC: 4175128. DOI: 10.1055/s-0034-1383042. View

Beckmann M, Stubs F, Koch M, Mallmann P, Dannecker C, Dietl A . Diagnosis, Therapy and Follow-up of Cervical Cancer. Guideline of the DGGG, DKG and DKH (S3-Level, AWMF Registry No. 032/033OL, May 2021) - Part 1 with Recommendations on Epidemiology, Screening, Diagnostics and Therapy. Geburtshilfe Frauenheilkd. 2022; 82(2):139-180. PMC: 8837407. DOI: 10.1055/a-1671-2158. View

Butea-Bocu M, Muller G, Pucheril D, Kroger E, Otto U . Is there a clinical benefit from prostate cancer center certification? An evaluation of functional and oncologic outcomes from 22,649 radical prostatectomy patients. World J Urol. 2020; 39(1):5-10. DOI: 10.1007/s00345-020-03411-9. View

Fehm T, Stubs F, Koch M, Mallmann P, Dannecker C, Dietl A . Diagnosis, Therapy and Follow-up of Cervical Cancer. Guideline of the DGGG, DKG and DKH (S3-Level, AWMF Registry No. 032/033OL, May 2021) - Part 2 with Recommendations on Psycho-oncology, Rehabilitation, Follow-up, Recurrence, Palliative Therapy and.... Geburtshilfe Frauenheilkd. 2022; 82(2):181-205. PMC: 8855983. DOI: 10.1055/a-1671-2446. View

Haj A, Doenitz C, Schebesch K, Ehrensberger D, Hau P, Putnik K . Extent of Resection in Newly Diagnosed Glioblastoma: Impact of a Specialized Neuro-Oncology Care Center. Brain Sci. 2018; 8(1). PMC: 5789336. DOI: 10.3390/brainsci8010005. View

Kowalski C, Graeven U, von Kalle C, Lang H, Beckmann M, Blohmer J . Shifting cancer care towards Multidisciplinarity: the cancer center certification program of the German cancer society. BMC Cancer. 2017; 17(1):850. PMC: 5731059. DOI: 10.1186/s12885-017-3824-1. View

10.

Kreienberg R, Wockel A, Wischnewsky M . Highly significant improvement in guideline adherence, relapse-free and overall survival in breast cancer patients when treated at certified breast cancer centres: An evaluation of 8323 patients. Breast. 2018; 40:54-59. DOI: 10.1016/j.breast.2018.04.002. View

11.

Langendam M, Piggott T, Nothacker M, Agarwal A, Armstrong D, Baldeh T . Approaches of integrating the development of guidelines and quality indicators: a systematic review. BMC Health Serv Res. 2020; 20(1):875. PMC: 7493171. DOI: 10.1186/s12913-020-05665-w. View

12.

Nothacker M, Langer T, Weinbrenner S . [Quality indicators for National Disease Management Guidelines using the example of the National Disease Management Guideline for "Chronic Heart Failure"]. Z Evid Fortbild Qual Gesundhwes. 2011; 105(1):27-37. DOI: 10.1016/j.zefq.2010.07.003. View

13.

Nothacker M, Stokes T, Shaw B, Lindsay P, Sipila R, Follmann M . Reporting standards for guideline-based performance measures. Implement Sci. 2016; 11:6. PMC: 4714427. DOI: 10.1186/s13012-015-0369-z. View

14.

Oonk M, Planchamp F, Baldwin P, Mahner S, Mirza M, Fischerova D . European Society of Gynaecological Oncology Guidelines for the Management of Patients with Vulvar Cancer - Update 2023. Int J Gynecol Cancer. 2023; 33(7):1023-1043. PMC: 10359596. DOI: 10.1136/ijgc-2023-004486. View

15.

Ruckher J, Lobitz J, Follmann M, Derenz S, Schmidt S, Mensah J . Guideline-Based Quality Indicators for Kidney and Bladder Cancer in Germany: Development and Implementation. Urol Int. 2021; 106(4):360-367. DOI: 10.1159/000517893. View

16.

Schmitt J, Klinkhammer-Schalke M, Bierbaum V, Gerken M, Bobeth C, Rossler M . Initial Cancer Treatment in Certified Versus Non-Certified Hospitals. Dtsch Arztebl Int. 2023; 120(39):647-654. PMC: 10622058. DOI: 10.3238/arztebl.m2023.0169. View

17.

Schulmeyer C, Koch M, Dietl A, Stuebs F, Behrens A, Renner S . Standardized Procedures for Patients with Dysplasia and Other Diseases of the Cervix, Vulva, and Vagina at a Certified Dysplasia Unit Prior to the Introduction of the Organized Cervical Cancer Screening Program. Geburtshilfe Frauenheilkd. 2023; 83(8):1031-1042. PMC: 10427204. DOI: 10.1055/a-1934-1686. View

18.

Stuebs F, Mehlhorn G, Gass P, Schulmeyer C, Adler W, Strehl J . Concordance rate of vulvoscopic findings in detecting early vulvar neoplasia. Gynecol Oncol. 2020; 157(2):463-468. DOI: 10.1016/j.ygyno.2020.02.026. View

19.

Stuebs F, Beckmann M, Fehm T, Dannecker C, Follmann M, Langer T . Implementation and update of guideline-derived quality indicators for cervical cancer in gynecological cancer centers certified by the German Cancer Society (DKG). J Cancer Res Clin Oncol. 2023; 149(14):12755-12764. PMC: 10587177. DOI: 10.1007/s00432-023-05132-z. View

20.

Trautmann F, Reissfelder C, Pecqueux M, Weitz J, Schmitt J . Evidence-based quality standards improve prognosis in colon cancer care. Eur J Surg Oncol. 2018; 44(9):1324-1330. DOI: 10.1016/j.ejso.2018.05.013. View