Percentage of Patients who Died from Cancer Receiving Systemic Cancer-Directed

Measure Specification

Cancer is the second leading cause of death in the United States). Chemotherapy utilization at the end of life is associated with a worse quality of life near death among patients with good baseline performance status, ED visits, cardiopulmonary resuscitation, mechanical ventilation, dying in an ICU, and higher estimated costs of care. The 2015 Institute of Medicine report Dying in America states that a palliative approach often offers the best chance of maintaining the highest possible quality of life for those living with advanced serious illness and proposes, as a core component to quality end-of-life care, to offer palliative care services and personalize revision of the care plan and access to services based on the changing needs of the patient and family.

The purpose of this measure is to encourage timely enrollment in palliative care that focuses on symptom management, rather than low utility and aggressive treatments, among dying cancer patients. The ultimate outcome is an improved quality of life, positive death experience, and reduction in resource utilization costs. Lastly, the National Comprehensive Cancer Network (NCCN) Quality and Outcomes Committee recently reviewed 528 existing oncological quality measures and concepts to identify important cancer quality and outcome measures.

Measures and concepts were evaluated according to importance, supporting evidence, opportunity for improvement, and ease of measurement; CBE 0210 was one of seven cross-cutting measures selected for endorsement as a universally appropriate measure to evaluate quality of oncology care.

This measure is based on ASCO and National Comprehensive Cancer Network (NCCN) Guidelines: 1. Clinicians should refer patients with advanced solid tumors and hematologic malignancies to specialized interdisciplinary palliative care teams that provide inpatient and outpatient care early in the course of disease, alongside active treatment of their cancer (Moderate, Strong) (ASCO, 2024).

2. Palliative care for patients with advanced cancer should be delivered through interdisciplinary palliative care teams, with consultation available in both outpatient and inpatient settings (Intermediate, Moderate) (ASCO, 2024). 3. Patients with advanced cancer should receive palliative care services, which may include a referral to a palliative care provider.

Essential components of palliative care include (Intermediate, Moderate) (ASCO 2024): • Rapport and relationship building with patient and family caregivers • Symptom, distress, and functional status management (eg, pain, dyspnea, fatigue, sleep disturbance, mood, nausea, or constipation) • Exploration of understanding and education about illness and prognosis • Clarification of treatment goals • Assessment and support of coping and spiritual needs • Assistance with medical decision making • Coordination with other care providers • Provision of referrals to other care providers as indicated 4.

“In general, patients with weeks to days to live (e.g., dying patients) and comfort-oriented goals should discontinue all treatments not directly contributing to patient comfort. Intensive palliative care focusing on symptom management should be provided in addition to preparation for the dying process. Referral for hospice care should be placed, if not already done” (Category 2A) (NCCN, 2024).

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this patient-periodic measure should be submitted a minimum of once per patient per timeframe specified by the measure for the performance period. This is an inverse measure which means a lower calculated performance rate for this measure indicates better clinical care or control.

The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.