Quality Metrics and Quality Improvement Program Can Improve Cervical Cancer Care

A recent research effort underscores the importance of not only defining quality metrics in cervical cancer, but also tracking adherence to identify areas of improvement that will optimize patient care and outcomes. Cleveland Clinic researchers, led by Sudha Amarnath, MD, Co-Director of the Gynecologic Cancer Program and Assistant Professor of Radiation Oncology, found that a dedicated weekly huddle can help reduce barriers to diagnosis and treatment initiation.

Results from this retrospective analysis, which were presented during the ASTRO 2023 annual meeting, demonstrated that earlier and more frequent referrals to social work as well as multi-disciplinary discussions can impact patient treatment and, as a result, their outcomes.

“Cervical cancer is a relatively rare disease that, if not caught early, is typically associated with devastating outcomes,” says Dr. Amarnath, while noting that the survival rate of this condition has remained relatively unchanged over the last 20 years. “Additionally, cervical cancer patients often face significant barriers to high-quality care due to socio-economic factors and health care system failures.”

Recognizing the need to improve care for this patient population, Dr. Amarnath and her colleagues set out to determine if the development of evidence-based quality metrics and tracking adherence would help identify systemic issues that could be addressed.

“In September 2021, we implemented a weekly cervical cancer huddle, which includes a physician, nurse practitioner, social workers and other caregivers to discuss all newly diagnosed patients before treatment begins,” explains Dr. Amarnath. “Our main focus is to find ways to better serve our patients and improve their quality of care.”

Methods & findings

Dr. Amarnath and her colleagues conducted a retrospective review of cervical cancer patients who were treated at Cleveland Clinic between January 2019 and December 2022. They assessed the following quality metrics in newly diagnosed patients:

• Tumor board presentation
• Outside pathology review
• Receipt of PET CT / MRI prior to treatment start
• Use of radiology and pathology synoptic reports
• Receipt of external beam radiation and brachytherapy
• Completion of chemotherapy and radiation within 56 days
• Receipt of post-treatment PET CT
• Referral to social work
• Laparotomy for radical hysterectomy

Additionally, the study authors tracked the impact of the weekly cervical cancer huddle on pre-treatment quality metrics before and after implementation. In this study, 173 patients with newly diagnosed cervical cancer were identified. The majority of cases were squamous cell carcinoma (61%). Forty-four percent were stage I, 39% were stage II or III and 16% were stage IV.

Dr. Amarnath and her team reported that during the study period, 65% of patients underwent imaging prior to treatment initiation and 73% had a radiology synoptic report on MRI. Additionally, they found that 71% of the patients who underwent a hysterectomy had pathology synoptic reports.

The data also revealed that 90% of eligible patients received both external beam radiation and brachytherapy, 91% completed chemotherapy and radiation within 56 days and 96% had a post-treatment PET CT within three to six months.

When reviewing the impact of the huddle on pre-treatment quality metrics, Dr. Amarnath and fellow investigators found that tumor board presentation increased from 38% to 73%. The researchers also observed an increase in social work referral (42% to 59%), outside pathology review (64% to 83%) and use of laparotomy (67% to 81%).

“We also saw an increase in the number of patients who had open surgery instead of minimally invasive surgery,” says Dr. Amarnath, while highlighting a large, randomized trial that demonstrated better outcomes among patients who have open surgery compared with those who undergo a minimally invasive approach.

Implications & next steps

This analysis highlights the importance of tracking cervical cancer metrics and offers a framework for quality improvement efforts. “We are always trying to find ways to improve both patient care and patient outcomes,” says Dr. Amarnath. “These findings offer a baseline, and give us a clear picture of where we should be focusing our efforts.”

While Dr. Amarnath acknowledges that developing an initiative like this requires extensive time and resources, she urges organizations to take it one step at a time. “It is challenging to meet all of these metrics for every single patient,” she notes. “But if we don’t start, we won’t know what we are doing well and what still needs improvement.”

Moving forward, Dr. Amarnath and her colleagues plan to use what they have learned to collaborate with disciplines across the continuum of care to improve the quality of care provided to patients with cervical cancer at Cleveland Clinic.

“At the national level, I would like to see the development of an accreditation program or center of excellence for cervical cancer to help patients find institutions that are delivering the highest quality of care,” she says. “We care deeply about this patient population and are dedicated to ensuring that we can improve outcomes for cervical cancer.”