Quality measurements for the Sarcoma Registry

Last updated: 6/26/2024

The Sarcoma Registry's annual report provides an overview of selected parts of sarcoma treatment in Norway. Results in the report show that there is a high degree of centralisation of sarcoma treatment to the four university hospitals that have established multidisciplinary teams for sarcoma; Oslo University Hospital, Haukeland University Hospital, St. Olavs Hospital and the University Hospital of Nord Norway.

Quality measurements for the Sarcoma Registry

The figure shows the achievement of goals for the quality indicators defined by the Academic Council. The colored circles mark the degree of goal achievement in 2023. Red circle means low grade, yellow circle moderate, and green circle high degree of goal achievement. Specified target figures (as a percentage) show the requirement for a high degree of goal attainment.

The proportion of patients with Ewing's sarcoma and osteosarcoma who have been assessed with PET is 80 per cent, which gives a moderate degree of goal attainment.

The proportion of bone sarcomas referred to sarcoma centres after surgery/open biopsy is well within the target set. The proportion is somewhat higher for soft tissue sarcomas in the extremities and trunk, but is still within a high degree of goal attainment nationally.

The proportion of patients with Ewing and Osteosarcoma who have received chemotherapy within three weeks after surgery and the proportion who have received drug cancer treatment according to protocol achieve the desired target number. All the performance indicators have high target attainment.

In this year's report, several new figures on the treatment of sarcoma patients are presented. Among other things, it looks at the proportion of patients who receive chemotherapy near death. A goal in palliative cancer care must be to provide less targeted treatment that increases the risk of complications and hospitalizations. Palliative care will usually be most important in this phase.

High target attainment is ≤ 10%, moderate target attainment is 11% - 20% and low target attainment is > 20%.

Proportion of patients in 2021-2023 who have received chemotherapy within a month before death, divided by admission area RHF. From fig. 2.7 in the annual report.

Patients who have more than one case of cancer are excluded from the analysis. The largest proportion of patients is in the two largest health regions, which may also reflect the patient population and the treatment burden of these patients.

Another important outcome indicator is 5-year relative survival for non-metastatic Ewing sarcomas.

5-5-year relative survival for Ewing sarcoma in bone and soft tissue. From fig. 2.23 in the annual report.

The figure shows 5-year relative survival for Ewing sarcoma divided into metastatic, non-metastatic and others.

Ewing sarcoma occurs in both bone and soft tissue everywhere in the body. Localization in bones is the most usual. The treatment principles are the same regardless of location. Therefore, the professional council wishes to present survival in Ewing sarcoma divided by the spread of the disease together for all locations. Metastases at the time of diagnosis give a worse prognosis, although patients with few metastases at the time of diagnosis can also be cured.

The professional council has decided that 5-year relative survival for Ewing sarcoma in bone and soft tissue should be established as a quality indicator. Target figures have been set, and the next annual report will present results on survival for each regional health trust.

Quality improvements

Identified patient-oriented improvement areas:

The proportion of patients with Ewing sarcoma and osteosarcoma who are examined with PET-CT in primary examinations is still not within the target that has been set. In 2023, the completeness of this variable was assessed and improved in collaboration with the sarcoma centres. The hospitals must review their routines for the use of PET-CT in investigations, with the aim that more patients will be examined.
Three of the regional health trusts do not meet the target that 90 per cent of patients with Ewing sarcoma and cheese sarcoma should start chemotherapy within three weeks after surgery
Several patients in the South-East Health trust are referred to sarcoma centers after surgery/open biopsy, and the South-East Health trust is not within the target set in this indicator.
There are differences in drug cancer treatment of localized soft tissue sarcomas between the health regions.
There are differences in survival of soft tissue sarcomas in the extremities and trunk between the health regions.

Improvement measures:

The proportion of patients with Ewing sarcoma and osteosarcoma who are examined with PET-CT in the primary examination is too low.

Submitted data was reviewed and any errors identified were corrected.

There are differences in survival for soft tissue sarcomas of the extremities and trunk

Analyzes have been carried out where we have found that the differences mainly concern patients with localized disease, and only for certain morphological subgroups. More analyzes must be done to increase understanding of what influences survival in this patient group.

Improved reporting

The cancer register has had a major focus on increasing the degree of coverage in recent years, which has resulted in improved reporting to all the quality registers. The Cancer Registry of Norway has also created a separate reporting team that will work continuously to improve the degree of coverage.

The hospitals themselves must wish to receive training in reporting. This requires that both time, funds and personnel must be set aside. The quality register responsible has visited relevant hospitals and contributed with training in what they have needed. This has been both guidance in using KREMT (the Cancer Registry's reporting service) and cancer-specific reporting forms.

Coverage rate for clinical asassment reports for investigating hospitals from 2022 to 2023. From fig. 4.1 in the annual report.

The figure shows the degree of clinical coverage for reports of investigation at hospital level. The degree of coverage for the whole the country stands at 71.9 per cent overall for 2023.

There are large differences between the hospitals in the reporting of investigation notices. It is important that hospitals now take greater responsibility for reporting to the Sarcoma Register. It is only with a good degree of coverage that the results can be used for quality improvement nationally and in the hospitals.