UICC World Cancer Congress. Cancer Staging and Quality of Care

Transcription

1 UICC World Cancer Congress August 27 30, 2012, Montreal CANCER STAGE: A neglected cornerstone of Cancer Control Cancer Staging and Quality of Care Christian Wittekind Institut für Pathologie UKL 1

2 Agenda! AIM: An optimal quality of care for cancer patients (worldwide)! What is Cancer Staging?! Definition and elements of quality of care Christian Wittekind Institut für Pathologie UKL 2

3 Cancer Staging Quality of Care Christian Wittekind Institut für Pathologie UKL 3

4 Cancer Staging Quality of Care Q u a l i t y M a n a g e m e n t Christian Wittekind Institut für Pathologie UKL 4

5 Cancer Staging describes the extent (= severity) of a person s cancer based on the size/extent of the primary tumour and how far it is spread in the body T = Primary tumour N = Regional lymph nodes M = Distant metastasis Stage 0 Stage I Stages (stage grouping) Stage II Stage III Stage IV Christian Wittekind Institut für Pathologie UKL 5

6 Cancer Staging Stage I Cancer is in its early phase Stage IV Cancer has metastasized to other organs knowing the stage of cancer helps physicians plan appropriate treatment (quality of care!) " Determine the likely outcome of the disease " Knowing the stage is important in identifying suitable clinical trials " Population-based staging data can be used in cancer system surveillance, planning and improvements Christian Wittekind Institut für Pathologie UKL 6

7 Objectives of the UICC TNM System 1. To aid the clinician in the planning of treatment 2. To give some indication of prognosis 3. To assist in evaluation of the results of treatment 4. To facilitate the exchange of information between treatment centers 5. To contribute to the continuing investigation of human cancer 6. To support cancer control activities Christian Wittekind Institut für Pathologie UKL 7

8 Even today Cancer Staging should be more detailed: pt1pn0m0 pt2pn0m0 pt3pn1m0 pt4pn2m Challenge: To describe the tumour heterogeneity! Clinical characteristics! Disease courses! Response to specific treatments + Differences in Morphology, immunopathology, molecular characteristics of a tumour Christian Wittekind Institut für Pathologie UKL 8

9 Cancer Staging should be more detailed: pt1pn0m0 pt2pn0m0 pt3pn1m0 pt4pn2m0 Challenge: To describe the tumour heterogeneity! Clinical characteristics! Disease courses! Response to specific treatments + Differences in Morphology, immunopathology, molecular characteristics of a tumour The Lexicon Project: # Anatomy Group # Tumor Profile Group Christian Wittekind Institut für Pathologie UKL 9

10 Cancer Staging Aspects of Quality Management TNM TNM TNM TNM Christian Wittekind Institut für Pathologie UKL 10

11 Cancer Staging Aspects of Quality Management Stage IV Stage IV Stage IV Stage IV Stage I Stage I Stage I Stage I Lung Cancer: Population-based distribution of cancer stage Christian Wittekind Institut für Pathologie UKL 11

12 Cancer Staging Quality of Care Aim: To deliver a high-quality staging product to cancer care Christian Wittekind Institut für Pathologie UKL 12

13 Quality of Care - Institute of Medicine (IOM) the degree to which health services for individual and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge Christian Wittekind Institut für Pathologie UKL 13

14 Quality of Care - Different perspectives! Patients! Physicians! Health plan point of view! Public health perspective Christian Wittekind Institut für Pathologie UKL 14

15 Quality of Care - Different perspectives Patients! Care in terms of its responsiveness to their individual needs! Access to and choice of services (doctors, treatments) that maximize their ability to work and enjoy life Physicians! Care in terms of their ability to exercise their medical treatment to optimize outcome for patients Christian Wittekind Institut für Pathologie UKL 15

16 Quality of Care - Different perspectives Health plan s point of view! Efficiency! Appropriate use of diagnostic and therapeutic technologies! Maintenance of high levels of patient satisfaction with care Public health perspective! High levels of access to primary care! Effective prevention! Low morbidity and mortality rate Christian Wittekind Institut für Pathologie UKL 16

17 Quality of Care - Institute of Medicine (IOM) Poor quality INCOMPLETE AND INSUFFICIENT STAGING Too much care (e.g., unnecessary tests, medications or procedures with associated risks and side effects) Too little care (e.g., not receiving a life saving surgical procedure Wrong care (e.g., medicines that should not be given together, poor surgical techniques) Good quality = Appropriate services in a technical competent manner (staging??), with good communication, shared decision making, and cultural sensivity. Christian Wittekind Institut für Pathologie UKL 17

18 Measurements of Quality of Care! Quality of care measurements! Quality indicators! Quality of care indicators Quality of quality of care indicators Christian Wittekind Institut für Pathologie UKL 18

19 Factors influencing the Quality of Care! Treatment! Quality of life! Good communication! Shared decision making! Cultural sensivity Christian Wittekind Institut für Pathologie UKL 19

20 Factors influencing the Quality of Care! Treatment Personalized Treatment! Quality of life! Good communication! Shared decision making! Cultural sensivity Dependent on stage Dependent on curation Christian Wittekind Institut für Pathologie UKL 20

21 Factors influencing the Quality of Care Quality of care aspects with the use of quality indicators are established in only a few cancer entities! Colorectal cancer! Breast cancer! Prostate cancer Christian Wittekind Institut für Pathologie UKL 21

22 Cancer Staging accurate Cancer stage information can improve quality of care! from the patient s perspective (location, size, stage)! from the cancer system s perspective (linking stage of cancer with outcome and treatment data) identifying new ways to improve the delivery of care Christian Wittekind Institut für Pathologie UKL 22

23 Thank you very much for your attention! Christian Wittekind Institut für Pathologie UKL 23