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  • Measure Summary
  • NQMC:011093
  • Jan 2016

Brain and central nervous system (CNS) cancer: proportion of patients with resectable malignant glioma (with enhancing component on pre-operative imaging) undergoing surgery (biopsy and surgical resection) where greater than 90% reduction in tumour volume is achieved.

NHS Scotland, Scottish Cancer Taskforce. Brain and central nervous system cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jan. 39 p. [24 references]

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Clinical Quality Measures: Outcome

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the proportion of patients with resectable malignant glioma (with enhancing component on pre-operative imaging) undergoing surgery (biopsy and surgical resection) where greater than 90% reduction in tumour volume is achieved.

This Cancer Quality Performance Indicator (QPI) measure is separated into two parts. Please refer to the related NQMC measure summary, Brain and central nervous system (CNS) cancer: proportion of patients with malignant glioma (with enhancing component on pre-operative imaging) undergoing surgical resection where greater than 90% reduction in tumour volume is achieved.

Note from the National Quality Measures Clearinghouse: This measure is part of the QPIs collection. For more information, including a complete list of QPI measure sets, please visit the Healthcare Improvement Scotland Web site External Web Site Policy.

Rationale

The extent of surgical resection is an independent prognostic factor in grade III and grade IV malignant gliomas. Maximal safe surgical resection (greater than 90%) prolongs time to tumour recurrence (Stummer et al., 2006) and is associated with prolonged survival (Pichlmeier et al., 2008). Maximum safe surgical resection is recommended by several published guidelines (Alberta Health Services, 2008; Ryken et al., 2008).

Published evidence shows that 70% to 90% of patients judged eligible for maximal resection (greater than 90%) actually achieve this (depending on surgical technique used). It is less clear what proportion of patients has the potential for maximal safe surgical resection. This is possibly only 30% to 50% (Lacroix et al., 2001; Stupp et al., 2005).

Evidence for Rationale

Alberta Health Services. Anaplastic astrocytomas and oligodendrogliomas. Edmonton (Alberta): Alberta Health Services; 2008.

Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F, Lang FF, McCutcheon IE, Hassenbusch SJ, Holland E, Hess K, Michael C, Miller D, Sawaya R. A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg. 2001 Aug;95(2):190-8. PubMed External Web Site Policy

NHS Scotland, Scottish Cancer Taskforce. Brain and central nervous system cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jan. 39 p. [24 references]

Pichlmeier U, Bink A, Schackert G, ALA Glioma Study Group. Resection and survival in glioblastoma multiforme: an RTOG recursive partitioning analysis of ALA study patients. Neuro Oncol. 2008 Dec;10(6):1025-34. PubMed External Web Site Policy

Ryken TC, Frankel B, Julien T, Olson JJ. Surgical management of newly diagnosed glioblastoma in adults: Role of cytoreductive surgery. J Neurooncol. 2008 Sep;89(3):271-86. PubMed External Web Site Policy

Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ, ALA-Glioma Study Group. Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol. 2006 May;7(5):392-401. PubMed External Web Site Policy

Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO, European Organisation for Research and Treatment of Cancer Brain [TRUNC], National Cancer Institute of Canada Clinical Trials Group. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005 Mar 10;352(10):987-96. PubMed External Web Site Policy

Primary Health Components

Brain/central nervous system (CNS) cancer; malignant glioma; biopsy; surgical resection; reduction in tumour volume

Denominator Description

All patients with malignant glioma (with enhancing component on pre-operative imaging) undergoing surgery (biopsy and surgical resection) (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of patients with resectable malignant glioma (with enhancing component on pre-operative imaging) undergoing surgery (biopsy and surgical resection) where greater than 90% reduction in tumour volume is achieved (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

The collection of data is piloted on a small number of patient records using a paper data collection form produced by the Information Services Division (ISD). The aim is to identify any anomalies or difficulties with data collection prior to full implementation. At least one NHS board in each Regional Cancer Network participates in the pilot.

Evidence for Extent of Measure Testing

NHS Scotland. National cancer quality performance indicators: overview of development process. Edinburgh (Scotland): NHS Scotland; 2012 Dec. 7 p.

State of Use

Current routine use

Current Use

Internal quality improvement

National reporting

Public reporting

Measurement Setting

Hospital Inpatient

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Unspecified

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Diagnostic Evaluation

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients with malignant glioma* (with enhancing component on pre-operative imaging) undergoing surgery (biopsy and surgical resection)

*Malignant gliomas include:

  • Glioblastoma multiforme (GBM) and its variants (e.g., gliosarcoma)
  • Anaplastic astrocytoma (AA)
  • Anaplastic oligodendrogliomas
  • Mixed tumours (e.g., oligoastrocytoma, glioblastoma with oligodenroglial component)
  • High-grade ependymoma

Exclusions
None

Exclusions/Exceptions

None

Numerator Inclusions/Exclusions

Inclusions
Number of patients with resectable malignant glioma (with enhancing component on pre-operative imaging) undergoing surgery (biopsy and surgical resection) where greater than 90%* reduction in tumour volume is achieved

*Percentage tumour reduction should be assessed by comparing pre-surgical imaging to post-surgical 72 hour magnetic resonance imaging (MRI).

Exclusions
None

Numerator Search Strategy

Fixed time period or point in time

Data Source

Electronic health/medical record

Paper medical record

Type of Health State

Physiologic Health State (Intermediate Outcome)

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Prescriptive standard

Prescriptive Standard

Target: 30%

Evidence for Prescriptive Standard

NHS Scotland, Scottish Cancer Taskforce. Brain and central nervous system cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jan. 39 p. [24 references]

Original Title

QPI 6 (ii) – maximal surgical resection.

Measure Collection Name

Cancer Quality Performance Indicators (QPIs)

Measure Set Name

Brain and Central Nervous System Cancer

Submitter

NHS Scotland - National Government Agency [Non-U.S.]

Scottish Cancer Taskforce - National Government Agency [Non-U.S.]

Developer

NHS Scotland - National Government Agency [Non-U.S.]

Scottish Cancer Taskforce - National Government Agency [Non-U.S.]

Funding Source(s)

Scottish Government

Composition of the Group that Developed the Measure

Brain/Central Nervous System (CNS) Cancer QPI Development Group

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2016 Jan

Measure Maintenance

The Cancer Quality Performance Indicators (QPIs) will be kept under regular review and be responsive to changes in clinical practice and emerging evidence.

Date of Next Anticipated Revision

2017 Aug

Measure Status

This is the current release of the measure.

Source(s)

NHS Scotland, Scottish Cancer Taskforce. Brain and central nervous system cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jan. 39 p. [24 references]

Measure Availability

Source document available from the Healthcare Improvement Scotland Web site External Web Site Policy.

For more information, contact the Healthcare Improvement Scotland at Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland EH12 9EB; Phone: 0131 623 4300; E-mail: comments.his@nhs.net; Web site: www.healthcareimprovementscotland.org/ External Web Site Policy.

Companion Documents

The following is available:

  • NHS Scotland. National cancer quality performance indicators: overview of development process. Edinburgh (Scotland): NHS Scotland; 2012 Dec. 7 p. This document is available from the Healthcare Improvement Scotland Web site External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on May 4, 2017. The information was verified by the measure developer on May 23, 2017.

Copyright Statement

No copyright restrictions apply.

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