The Canadian Partnership Against Cancer, in collaboration with the Canadian Association of Pathologists (CAP), is supporting a project that will provide a framework for more accurate cancer diagnosis and better treatment planning across the country.
“High-quality care utilizes the best and most current professional knowledge, and is safe, effective, patient-centred, timely, efficient and equitable,” says Margaret Keresteci, director, Quality Initiatives Implementation at the Partnership.
“The development of quality assurance in the processes that underlie diagnosis and treatment will help ensure all patients receive care that consistently meets these standards.”
Boosting best practices
Central to high-quality patient care is standardization in diagnostic immunohistochemistry, a process of examining abnormal (possibly cancerous) cells. Correct diagnosis of several kinds of cancer depends on IHC testing and these processes can be highly complex.
Class I IHC tests are used by pathologists to produce correct and more definitive diagnoses of cancer, while Class II tests are used to report the results of prognostic and predictive markers in cancer. Class II tests are crucial in determining the most appropriate treatment as they further define the type of cancer. An example of Class II tests is testing for hormone receptors in breast cancer tissue so that appropriate treatment options can be chosen. It is problems with this type of testing that have received recent public attention as errors with breast-cancer testing have come to light.
There are three main components of this joint Partnership-CAP initiative underway.
- Checklists to support uniform standards: In the first step of this project, standardized process documents are being developed for each class of IHC testing. These electronic reports allow guidelines to be embedded and will be the basis for implementing uniform standards and improving accuracy in diagnostic IHC processes nationwide. This initiative is based on widespread evidence that such checklists can greatly improve the efficiency and quality of complex processes.
- Education and collaboration: At the same time, the development of educational activities supports collaboration and the optimal application of evidence and best practices. Among the key initiatives, a new online tool provides a mechanism for disseminating case content to be used for case-oriented evaluations using digital microscopy tailored to a pathologist’s practice. Such exchanges are vital to quality improvements.
- Laboratory quality-control system: The final component of this project focuses on implementation of separate and independent review of IHC testing. The external Canadian IHC Quality Control Program builds on existing work to systematically monitor and improve the proficiency of IHC testing laboratories nationwide. Creation of this Canada-wide quality-control program will facilitate participation by labs nationwide and, eventually, by international stakeholders, regardless of jurisdiction or existing accreditation requirements.