Table 2. Core metrics for patient navigation during cancer treatment.
Domains | Metrics | Notes on operationalization of these metrics | Quality/benchmark |
---|---|---|---|
Goals of treatment | Palliative vs. curative intent established | Provides data regarding possible goals for treatment that can be tracked as appropriate depending on disease status | |
Timeliness of care | Consult with oncology provider to first treatment date | Calculated as time in days between dates | Institutional specific baseline* |
Time intervals between modalities (surgery to radiation, chemotherapy to surgery/radiation) | Calculated as time in days between dates | Institutional specific baseline | |
Concordant start dates of radiation therapy and chemotherapy (when indicated/relevant) | Yes/no | Institutional specific baseline. <br>For certain treatment regimens that require coordination of chemotherapy and RT, the benchmark should be 100% concordance. | |
Treatment adherence | Recommended surgery performed, guideline adherent | Yes/no | Benchmark should be 100%.<br>Can compare with institutional specific baseline. |
Recommended chemotherapy received/completed | Yes/no | Benchmark should be 100%.<br>Can compare with institutional specific baseline. | |
Recommended radiation therapy received/completed | Yes/no | Benchmark should be 100%.<br>Can compare with institutional specific baseline. | |
Radiation therapy treatment days missed | Not including weekends/holidays | Institutional specific baseline | |
Reasons for radiation therapy days missed | Particular attention to reasons not related to medical indications for omission of radiation treatment; data can be used to tailor barrier tracking and resolution. | ||
Chemotherapy cycles missed/omitted | Particular attention to whether reasons outside of medical indications resulted in cycles omitted; data can be used to tailor barrier tracking and resolution. | ||
On-treatment appointments missed | Institutional specific baseline | ||
Guideline adherence | Staging work-up/tests completed | Yes/no | Benchmark should be 100%.<br>Can compare with institutional specific baseline |
Breast conservation therapy (BCT)vs. mastectomy for BCT eligible breast cancer patients | Especially in settings/populations where barriers exist to receipt of a course of radiation therapy as part of BCT | Institutional specific baseline. <br>When institutional baseline is not available, rates published in the literature for similar populations can be used for comparison. | |
Receipt of adjuvant chemotherapy for colorectal cancer patients (when appropriate) | Yes/no | Institutional specific baseline. <br>When institutional baseline is not available, rates published in the literature for similar populations can be used for comparison. | |
Receipt of adjuvant hormone therapy when appropriate (breast, prostate cancer patients) | Yes/no | Institutional specific baseline | |
Standard of care delivered, NCCN guideline adherence | For programs where navigators have clinical knowledge/training | Institutional specific baseline | |
Health services utilization | Unplanned hospitalizations (preventable; e.g., non-infectious) | For analyses, can adjust for reasons for hospitalization when comparing to a control cohort | Institutional specific baseline. |
ER visits | Institutional specific baseline. | ||
Clinical trial participation | Trial availability | Yes/no | Institutional specific baseline |
Trial participation | Yes/no | Institutional specific baseline.<br>When institutional baseline is not available, rates published in the literature for similar populations can be used for comparison. | |
Reason for non-participation if clinical trial if offered/patient eligible | Data can be used for barrier tracking and resolution. | ||
Care coordination | Integration of adjuvant therapies where appropriate | Yes/no | Institutional specific baseline; benchmark goal of 100%. |
Ancillary services recommended/received (e.g., nutrition, social work, physical therapy, etc) | Yes/no | Institutional specific baseline | |
Medication and devices prescribed/received | Yes/no | Institutional specific baseline; benchmark goal of 100%. | |
Clinical outcomes | Stage at presentation | Institutional specific baseline.<br>When institutional baseline is not available, rates published in the literature for similar populations with same cancer subtype can be used for comparison. | |
Date of last follow up | Needed for calculation of survival and recurrence outcomes | ||
Survival data | Institutional specific baseline | ||
Recurrence data | Institutional specific baseline |
Institutional specific baseline can be determined from review of records for historical cohort with preference for a cancer subtype, race, and sex-matched cohort whenever possible.