Impact of quality indicators on adherence to National and European guidelines for renal cell carcinoma

Abstract

Objective: The aim of this population-based study was to evaluate the impact of quality indicators on the adherence to guidelines for renal cell carcinoma (RCC). Material and methods: Since 2005, virtually all patients with newly diagnosed RCC in Sweden have been registered in the National Swedish Kidney Cancer Register (NSKCR). The register contains information on histopathology, nuclear grade, clinical stage, preoperative work-up, treatment, recurrence and survival. In addition, a number of quality indicators have been measured in the register aiming to increase the quality of care. The quality indicators are: the coverage of the register, histology reports, preoperative chest computed tomography (CT), partial nephrectomy, laparoscopic surgery, centralization to high-volume hospitals and waiting times. Results: A total of 8556 patients with diagnosed RCC were registered from 2005 to 2013 (99% coverage). In 2013, 99% of the histopathology reports were standardized. The number of patients with preoperatively chest CT increased from 59% in 2005 to 89% in 2013. The proportion of patients with RCC T1aN0M0 who underwent partial nephrectomy increased from 22% in 2005 to 56% in 2013. Similarly, laparoscopic radical nephrectomies increased from 6% in 2005 to 24% in 2013. The median tumour size at detection decreased from 60 mm in 2005 to 55 mm in 2013. The proportion of patients who were incidentally detected increased from 43% in 2005 to 55% in 2013. Conclusions: The data show an improved adherence to the guidelines for RCC as measured by quality indicators and a steady process of earlier detection of patients with RCC.

Keywords:

• Population-based
• quality indicators
• renal cell carcinoma
• surgery
• Sweden
• tumour size
• tumour type

Acknowledgements

The members of the NSKCR are: Börje Ljungberg (chairman), Stina Christensen, Britt-Inger Dahlin, Peter Elfving, Ulrika Harmenberg, Benny Holmström, Annika Håkansson, Åsa Jellvert, Per Lindblad, Magnus Lindskog, Sven Lundstam, Ann-Helén Scherman-Plogell, Andreas Thorstenson, Emma Ulvskog and Janos Vasko.

Funding: The study was supported by grants from Umeå University, and Lions Cancer Research Foundation, Umeå (BL), the Research Foundation at the Urology Department of Sahlgrenska University Hospital, the Foundation of Anna-Lisa and Bror Björnsson (SL), the Stockholm Cancer Society and Capio St Görans Hospital (AT).

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.