Changes in the quality of cancer care as assessed through performance indicators during the first wave of the COVID-19 pandemic in 2020: a scoping review
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Abstract
Background
Cancer comprises a high burden on health systems. Performance indicators monitoring cancer outcomes are routinely used in OECD countries. However, the development of process and cancer-pathway based information is essential to guide health care delivery, allowing for better monitoring of changes in the quality of care provided. Assessing the changes in the quality of cancer care during the COVID-19 pandemic requires a structured approach considering the high volume of publications. This study aims to summarize performance indicators used in the literature to evaluate the impact of the COVID-19 pandemic on cancer care (January-June 2020) in OECD countries and to assess changes in the quality of care as reported via selected indicators.
Methods
Search conducted in MEDLINE and Embase databases. Performance indicators and their trends were collated according to the cancer care pathway.
Results
This study included 135 articles, from which 1013 indicators were retrieved. Indicators assessing the diagnostic process showed a decreasing trend: from 33 indicators reporting on screening, 30 (91%) signalled a decrease during the pandemic ( n = 30 indicators, 91%). A reduction was also observed in the number of diagnostic procedures ( n = 64, 58%) and diagnoses ( n = 130, 89%). The proportion of diagnoses in the emergency setting and waiting times showed increasing trends ( n = 8, 89% and n = 14, 56%, respectively). A decreasing trend in the proportion of earliest stage cancers was reported by 63% of indicators ( n = 9), and 70% ( n = 43) of indicators showed an increasing trend in the proportion of advanced-stage cancers. Indicators reflecting the treatment process signalled a reduction in the number of procedures: 79%( n = 82) of indicators concerning surgeries, 72%( n = 41) of indicators assessing radiotherapy, and 93%( n = 40) of indicators related to systemic therapies. Modifications in cancer treatment were frequently reported: 64%( n = 195) of indicators revealed changes in treatment.
Conclusions
This study provides a summary of performance indicators used in the literature to assess the cancer care pathway from January 2020 to June 2020 in OECD countries, and the changes in the quality of care signalled by these indicators. The trends reported inform on potential bottlenecks of the cancer care pathway. Monitoring this information closely could contribute to identifying moments for intervention during crises.
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SciScore for 10.1101/2022.02.23.22271303: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable Studies were excluded if they did not provide empirical data on health services and NCD, namely: 1) editorials and commentaries, 2) prediction models, 3) clinical case reports; 4) diseases management or health services organization guidelines, 5) studies about the impact on healthcare workers, patients diagnosed with COVID-19, children, or pregnant women; 6) studies primarily performed in non-OECD countries. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Information sources: MEDLINE and Embase databases were selected to search for this study, given the large number … SciScore for 10.1101/2022.02.23.22271303: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable Studies were excluded if they did not provide empirical data on health services and NCD, namely: 1) editorials and commentaries, 2) prediction models, 3) clinical case reports; 4) diseases management or health services organization guidelines, 5) studies about the impact on healthcare workers, patients diagnosed with COVID-19, children, or pregnant women; 6) studies primarily performed in non-OECD countries. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Information sources: MEDLINE and Embase databases were selected to search for this study, given the large number of articles and their comprehensive coverage of the literature on health services delivery. MEDLINEsuggested: (MEDLINE, RRID:SCR_002185)Embasesuggested: (EMBASE, RRID:SCR_001650)Duplicates were removed using EndNote software. EndNotesuggested: (EndNote, RRID:SCR_014001)Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our study has some limitations. The heterogeneity of study designs, populations, diseases, indicators, and indicators’ definitions do not allow application of a meta-analysis approach and quantifying the real impact of the pandemic on cancer care. We also recognize potential bias that could arise from the inclusion of survey data, which rely on what respondents recall and report. However, a relevant number of surveys were conducted by international societies and networks of providers, which allows for the collection of credible information regarding changes in care. Surveys also show how medical societies and countries were unable to obtain these data using current health information systems and data structures. We acknowledge the patients’ perspective is not comprehensive since only a few surveys included patient-reported outcomes and experiences of care measures. The cancer care pathway is not complete in this study, as it did not address primary prevention, rehabilitation, and palliative care. Nonetheless, we provide a thorough overview of the cancer care pathway, from diagnosis to outcomes. The distribution of studies per country is not homogenous in this study, which does not allow to generalize these trends to all included countries or to fully assess disparities in cancer care between OECD countries. Care inequalities could have been exacerbated during this pandemic, which needs to be further studied regarding cancer care. The COVID-19 pandemic keeps evolving until the...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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