title: Clinical governance benchmarking issues in oncology: aggressiveness of cancer care and consumption of strong opioids. A single-center experience on measurement of quality of care.
abstract: OBJECTIVE
  The aggressiveness of cancer care near the end of life and the consumption of opioids are potential indicators of quality of care in palliative and end-of-life settings. The purpose of this article is to present a retrospective analysis regarding these themes and the adopted procedures to improve quality of care.
  
  
  METHODS
  We evaluated all cancer patients treated and deceased during 2008 and considered those who died and received any antiblastic therapy within 14 and 30 days prior to death. Moreover, we evaluated the annual consumption of pure opioids during 2007 and 2008 in our inpatient clinic. We found that 5% and 9% of all treated patients were still receiving antiblastic treatment near the end of life within respectively 14 and 30 days prior to death (respectively 29.6% and 51.5% of deceased patients). All but 2 patients died from progressive disease, one patient died from acute myocardial infarction during chemotherapy, and one of severe sepsis after chemotherapy for non-Hodgkin lymphoma. As regards the annual consumption of strong opioids, there was a 179% increase in the use of morphine-equivalent doses of oral long-acting opioids (+228% for oxycodone) after the introduction of daily pain measurement through a numerical rating scale.
  
  
  CONCLUSIONS
  To reduce the administration of chemotherapy near the end of life, we introduced the palliative prognostic score, to be administered to all advanced cancer patients with performance status of at least 2. To evaluate the effectiveness of analgesics and to reduce the cases of undertreatment of cancer pain, we adopted, in addition to the numerical rating scale, Cleeland's Pain Management Index. We are convinced that attempts to improve the quality of care can be achieved by the collaboration of all health professionals, patients and care givers.
authors.affiliation: Operative Unit of Medical Oncology, City Hospital of Belluno, Italy. petros.giovanis@ulss.belluno.it
authors.forename: Petros
authors.initials: P
authors.lastname: Giovanis
authors.forename: Giovanni
authors.initials: G
authors.lastname: De Leonardis
authors.forename: Antonella
authors.initials: A
authors.lastname: Garna
authors.forename: Viviana
authors.initials: V
authors.lastname: Lovat
authors.forename: Francesca
authors.initials: F
authors.lastname: Caldart
authors.forename: Annarita
authors.initials: A
authors.lastname: Quarta
authors.forename: Laura
authors.initials: L
authors.lastname: Moretto
authors.forename: Fausto
authors.initials: F
authors.lastname: Tuccia
authors.forename: Marilisa
authors.initials: M
authors.lastname: Marcante
authors.forename: Mauro
authors.initials: M
authors.lastname: Giusto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D019985:Benchmarking / Q000639:trends; D054976:Clinical Governance / Q000639:trends; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008495:Medical Oncology / Q000592:standards*; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement / Q000379:methods; D010166:Palliative Care / Q000379:methods / Q000592:standards*; D010348:Patient Care Team; D011379:Prognosis; D011787:Quality of Health Care / Q000639:trends; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013727:Terminal Care / Q000379:methods / Q000592:standards*
chemical_list: D000701:Analgesics, Opioid; D000970:Antineoplastic Agents