SAN DIEGOPreliminary data show that a new outcomes measurement tool developed by the Society of Gynecologic Oncologists (SGO) Outcomes Task Force is a reliable method for demonstrating quality of care to third parties. Lead author Alexander W. Kennedy, MD, of the Department of Gynecology and Obstetrics, Cleveland Clinic Foundation, reported on behalf of the task force at the SGOs 31st Annual Meeting.
The SGO hopes that its members will embrace this tool as a quality assurance measure once benchmarks have been established. We hope that we can eventually use it also for outcomes research, for example, as laparoscopic surgery becomes more widely used, Dr. Kennedy told ONI in an interview.
The outcomes tool includes preoperative, intraoperative, and 120-day postoperative assessments. Factors measured include demographics, patient-reported health status as measured by the SF36, comorbid conditions, living status, satisfaction surveys, operative events, and disease characteristics.
The SF36 is a widely used patient reported health measure developed by John Ware and owned by the Medical Outcomes Trust in Boston, Dr. Kennedy explained. It has been widely used in many types of patients, and norms have been developed for different populations and diseases. It divides health into physical and mental components, and has several domains within each.
More Than 1,000 Patients Needed
Dr. Kennedy reported data from a pilot study of 297 endometrial cancer patients surveyed at 11 sites from 1997 to 1999. We hope to continue to accrue patients from the pilot sites. We will be confident in using the data as benchmarks when we have more than 1,000 patients from a variety of practice styles and locations, he told ONI.
The mean age was 64.4 years; mean Quetelet Index was 33.2 kg/m2. Forty-eight percent of patients were on Medicare, and 25% belonged to a health maintenance organization (HMO). The mean comorbidity score was 19.1 out of a possible 100, which represents about 3 comorbid conditions per patient.
By FIGO stage, 74% of patients were stage I, 9% were stage II, 11% were stage III, and 5% were stage IV. By FIGO grade, 40% were grade 1, 35% were grade 2, and 24% were grade 3. Nearly all patients (92%) lived independently before surgery, and most (91%) continued to live independently after surgery.
Surgical procedures were total abdominal hysterectomy in 77% of patients, radical abdominal hysterectomy in 8%, laparoscopic hysterectomy in 9%, and vaginal hysterectomy in 1%. Mean length of stay was 3.3 days. Nearly all patients (99%) were staged, and 83% underwent lymph node sampling. Two patients required unplanned repeat surgery. Postoperative treatment included radiation therapy in 20% of patients and cytotoxic chemotherapy in 13%.
The patients mean satisfaction score was 86 (on a 0 to 100 scale) before surgery and 83 after surgery. The mean SF36 physical component score was 43.6 before surgery and 43.4 after surgery. The mental component score was 49.1 before surgery and 50.6 after surgery.
This tool has been developed so that any type of practice could use it. We are in the process of making it web-based so that the data can be managed electronically. The website is currently restricted to SGO members and is in development, Dr. Kennedy said. SGO members will be able to log onto the SGO Clinical Data Network site, and patients will be able to directly complete surveys on line.
The Outcomes Task Force has also developed a tool for patients presenting with a pelvic mass and one for patients with ovarian cancer undergoing surgery and subsequent chemotherapy. These tools will be tested in work done in conjunction with the National Ovarian Cancer Survivors Alliance. We are ready to launch this phase of the SGOs outcomes effort in the next several weeks, Dr. Kennedy said.