Improving the Quality of Outcomes of Complex Cancer Surgery Through National Standards: Lessons From Canada

Background and context: Evidence shows there is wide variability in cancer care service delivery and patient outcomes. Outcomes of complex surgery can be improved by following standards that outline optimal ways to plan, organize and deliver surgical care. While some cancer surgeries are associated with a high risk of adverse outcomes, they also offer the best option for a cure. To ensure optimal patient outcomes, deliberate approaches are needed to standardize the organization of complex care surgeries. Aim: Leverage the expertise of specialty-based and multidisciplinary communities to develop pan-Canadian standards of practice as a means to elevate the delivery of oncologic surgery in Canada. Strategy/Tactics: A phased, multimodal qualitative and quantitative approach was undertaken to develop evidence-based consensus standards for best practice in complex surgery, through the analysis of administrative data to examine access and outcomes of complex, advanced-care surgery and discussion with public representatives to explore trade-offs for reorganizing cancer surgery. Results informed a literature review to identify best practices in complex surgery. Expert panels were convened with disease specific specialty surgeons to inform the development of evidence-informed consensus standards. Draft standards were finalized after targeted review and validation by a wider community of healthcare professionals. Program/Policy process: The standards were endorsed by national professional organizations. An audit was conducted with all surgical programs in Canada to assess pan-Canadian compliance with the standards. Barriers to compliance were tracked to identify areas where local, regional or national activity could support quality initiatives. Outcomes: National standards were developed and highlighted: surgeon criteria, practice settings, and quality improvement. These comprehensive standards provide actionable recommendations that can be tailored to meet local needs. The standards will help organize care in way that maximizes patient outcomes while maintaining reasonable access to care. This work reflects a Canadian approach to a global problem around appropriate delivery of cancer surgical services and facilitates international conversations to mobilize effective knowledge transfer and best practices. What was learned: • Development of national standards is an iterative process that requires upfront buy-in from surgeons, multidisciplinary communities and national associations. Lessons learned from this initiative can support development of international demonstration projects and can help model a process that others could use. • Mechanisms to enhance knowledge of the optimal organization of complex surgery services requires multifaceted and sustained attention. Thoughtful exploration of how surgical care interfaces with other treatment modalities is paramount to ensure a seamless patient journey.