Getting valuable insights into medicine use for colorectal cancer through Real-World Data
About the collaboration
This project belongs to the Dutch Institute for Clinical Auditing (DICA) Medicines Program. The initiative runs periodic roundtable sessions with hospitals focused on selected therapeutic areas, including, among others, lung cancer, breast cancer, colorectal cancer, and rheumatoid arthritis. For this program, DICA collaborated with the Dutch Association of Hospital Pharmacists (NVZA) and with LOGEX, who carried out the analysis. LOGEX processed and assessed data from twenty-three invited hospitals.
Some of the participating hospitals participated in a live discussion around three colorectal cancer topics facilitated by DICA and LOGEX:
- Guidelines adherence: Clinical guidelines for colon cancer are relatively strict and articulated; this makes the analysis of adherence more objective than in most disease groups. The assessment is carried out by measuring treatment decisions, such as the time between surgery and the start of the high-cost drug treatment, or the length of the treatment (number of cycles). Differences between adherence before, during, and after COVID-19 were also studied.
- End-of-life analysis: A qualification of patients who started a new high-cost treatment in the last three months before they died. This section aims to discuss how to provide the best care to these patients while ending the treatment at the appropriate moment.
- Survival: The overall survival from the top two selected treatments was observed in the total DICA Medicine cohort and compared with the literature results.
The prescription of high-cost drugs for oncology and rheumatoid arthritis in the Netherlands has been a concern over the last few years. This program aims to approach how to improve their appropriate usage in patient care by combining existing data sources and giving insights into the outcomes of the prescribed therapeutics. The objective is to create awareness among the hospitals and stimulate their internal discussion on improving the quality of patient care and appropriate use of high-cost medicines.
Hospitals can evaluate their performance by comparing it to peers by providing a platform for discussion, using dashboards with data and deep-dive analytics during roundtable sessions.
With real world data we can take healthcare one step further. This study from DICA shows how essential it is that physicians and pharmacists continue to conduct collaborative research in this environment.Jan-Dietert Brugma (Board Member NVZA)
The performed analysis showed how well hospitals adhere to the guidelines, as no significant modifications to the clinical guidance were issued over the last years. The program also evaluated the impact of COVID-19 on hospitals’ performance and guidelines adherence. Some effects were detected, such as longer times between surgery and the start of the high-cost drug treatment. These differences were observable during 2020 compared to 2019 data, but normal values were registered again in 2021. Besides the variations during the COVID-19 years, hospitals were still within the boundaries of the guidelines. While determining opportunities for improvement, the analysis proved that hospitals showcase satisfactory results, even during the extraordinary pandemic.
When addressing the second theme, end-of-life analysis, within the program, we found some variation in the percentage of patients that started a new treatment shortly before they died. Across the different hospitals, the size of this group ranges from 20 to 50% of the total number of deceased patients. Patient information such as general characteristics, namely age and gender, and care pathways, including admissions, visits to the emergency department, and time from the first to the last treatment was gathered. With this explorative analysis, a discussion was started to understand the characteristics of this population, compare the differences and identify hospitals’ best practices.
The last topic, patient survival, was addressed by comparing a cohort of 1000 patients to large clinical studies. The two most used treatments prescribed in the guidelines were studied in separate survival plots and compared with the available literature. Correlating both data sources will allow for assessing if the expected outcomes promised in the trials can be achieved in the real world.
Real World Evidence makes it possible to understand and compare how different hospitals follow comparable treatment processes. Real-world data is a powerful source of information, but advanced analytics are needed to interpret it. Within the DICA Clinical Audit Medicines, LOGEX and DICA try to unbind this complexity by providing actionable insights during collaborative roundtable sessions with hospitals. Hospitals can learn from each other by actively participating in discussions and sharing knowledge and best practices. After the sessions, DICA and LOGEX pursue tracking hospitals’ indicators to monitor progress over time and verify at what pace the discussed insights convert into improvements in clinical practices.