Patterns and quality of therapeutic care for glioma: a population-based study in Belgium between 2016 and 2019

BACKGROUND: The study aimed to evaluate the patterns and quality of therapeutic care and pathological diagnosis for glioma patients by calculating process indicators across Belgian hospitals. MATERIALS AND METHODS: All Belgian patients newly diagnosed with glioma between 2016 and 2019 were identified in the Belgian Cancer Registry (BCR). The National Social Security Number was used to link pathology reports and databases providing information on diagnostic and therapeutic procedures and vital status. Eighteen process indicators for therapeutic care and seven for pathological diagnosis were assessed for measurability based on administrative data availability. Measurable indicators were reviewed by a multidisciplinary expert board, and a validation study was conducted in six pilot hospitals. Associations between process indicators and outcomes were explored where possible. RESULTS: Nine indicators for therapeutic care and five for pathological diagnosis were measurable, though five required reformulations due to shortcomings in administrative data, mainly regarding radiotherapy dose and number of fractions. Most indicators met the predefined targets, indicating the provision of qualitative care. No low-grade gliomas received chemo- or radiotherapy without prior pathological confirmation. Concomitant chemoradiotherapy was initiated in 93.1% of surgically treated and 88.9% of biopsied glioblastoma patients (target 90%). For grade 3 astrocytoma and oligodendroglioma, the use of adjuvant chemo- and radiotherapy increased over time, meeting the 90% target by 2019. However, timely initiation of chemoradiotherapy (within 6 weeks of resection) in high-grade glioma could be improved (79.8% versus target 95%). The proportion of patients receiving chemotherapy (3.5%) or radiotherapy (2.5%) in the last 14 days of life remained below the 5% target. CONCLUSIONS: This research provides valuable feedback to Belgian hospitals and health care providers in neuro-oncology care programmes, opening opportunities for quality enhancement. On an international level, it underscores the significance of standardized quality assessment methods in neuro-oncology, which could serve as a foundation for future benchmark initiatives.