Opportunities to improve outcomes by measuring the quality of precision oncology (QPRO)

Precision oncology is a cancer care framework that aims to develop and deliver treatments that are guided by the biological characteristics of each individual patient’s tumour, providing personalized care. To capitalize on the promise of precision oncology and improve outcomes for cancer patients, the quality of care delivered must reach the highest attainable standard. 

To help assess and improve the quality of precision oncology care in Canada, the Marathon of Hope Cancer Centres Network (MOHCCN) is funding a team of scientists whose goal is to develop patient-centred consensus-based clinical quality indicators to be used as national standards for precision oncology. The team is led by Drs Timothy Hanna (Queen’s University), Yvonne Bombard (University of Toronto and Unity Health Toronto) and Winson Cheung (University of Calgary) and includes members from institutions in Ontario, Alberta, British Columbia, Quebec and Nova Scotia. 

“Quality cancer care refers to care that is safe, equitable, effective, efficient, timely and patient-centred," explains Dr. Cheung. “By identifying key quality indicators that are relevant to patients and providers, this project will enable downstream evaluations and optimization of quality care to improve outcomes for cancer patients.” 

Although precision oncology is a rapidly expanding field, quality evaluations in this area remain understudied. There are few established quality indicators that are specific to precision oncology, and those that do exist are concentrated in common cancer types and do not consider important aspects such as equity of access to testing and treatment, test quality and quality of life. There is therefore a need to develop broader, more generalizable measures of quality that are applicable across cancer types and testing technologies. 

“To meet the promise of precision oncology to improve outcomes for cancer patients, it is important to build pan-Canadian readiness to measure and improve quality of precision oncology care, especially as the pace and scale of adoption of this framework continues to increase,” says Dr. Bombard.  

To begin to address this need, the study will build pan-Canadian experience in developing quality indicators for precision oncology. The team will start by conducting interviews with adult cancer patients contributing samples to the MOHCCN Gold Cohort to understand their perspectives on quality in precision oncology. Drawing from these interviews and their own experience with precision oncology, the team will then develop a list of candidate quality indicators. Next, they will refine this list using a method called a modified Delphi process to achieve consensus first within a patient group and a clinical expert group and then between the two groups. 

This approach, and especially the involvement of cancer patients in the process, will ensure that the final list reflects patient-centred quality indicators that reflect patient values and priorities. While recruiting participants, the team will also seek broad representation of person and disease characteristics that may influence views on quality of care – such as age, sex, gender, race, ethnicity, geography (e.g. province, rurality), cancer type and cancer stage – to incorporate diverse perspectives and promote equity in the development, definition and measurement of these quality indicators. 

The project will focus on the clinical aspects of precision oncology care that involve the use of comprehensive genomic profiling, specifically the whole-genome and transcriptome analysis (WGTA) that patients participating in the MOHCCN Gold Cohort receive. Topics to be discussed in the interview and consensus processes will include the use of comprehensive genomic profiling for (1) cancer detection, (2) informing treatment and (3) identifying germline mutations. 

Potential indicators may include, for example, structural measurements such as whether a program includes a patient-facing portal for patients to access their genomic profiling data and results and procedural measurements such as the proportion of patients who are offered at least one form of treatment based on their genomic profiling results within six months of those results being reported. 

This project will provide a strong foundation for future research measuring the quality indicators identified here and using that information to improve the quality of precision oncology care available to Canadians. Dr. Hanna emphasizes that this work “holds great promise to improve access to care, equity of care and value of care for the benefit of all Canadian cancer patients. It will also help position Canada as a global leader in high-quality precision oncology care, and future studies measuring quality indicators identified by our team as part of clinical trials will also help establish Canada as a competitive and ideal location for precision medicine trials.”