Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

Feasibility and challenges of measuring lung cancer quality indicators using linked registry data: lessons from New South Wales     (146471)

Kim-Lin Chiew 1 2 , Shalini Vinod 2 3 4 , Margot Lehman 5 6 , Puma Sundaresan 7 8 , Shanley Chong 9
  1. Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  2. School of Clinical Medicine, UNSW Sydney, Sydney, NSW, Australia
  3. Liverpool Cancer Therapy Centre, South Western Sydney Local Health District , Liverpool, NSW, Australia
  4. Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
  5. Department of Radiation Oncology, Princess Alexandra Hospital , Brisbane, Queensland, Australia
  6. Faculty of Medicine, The University of Queensland , Brisbane, Queensland , Australia
  7. Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
  8. Sydney West Radiation Oncology Network, Western Sydney Local Health District, Sydney, NSW, Australia
  9. Epidemiology and Health Analytics, Western Sydney Local Health District, North Parramatta, NSW, Australia

Aims: To evaluate the feasibility of measuring lung cancer quality indicators (QIs) using linked population-level registry and administrative datasets in NSW and identify limitations to implementation for quality improvement.

Methods: A cohort of 12,485 patients diagnosed with lung cancer in NSW public facilities (2008–2012) was analysed using linked NSW Clinical Cancer Registry and administrative datasets. Of 304 QIs identified from literature, 66 were feasible, 48 QIs were evaluated for compliance and 32 were compared against benchmarks and health system comparators. Data completeness, measurement feasibility, and variation in care across sociodemographic and health system factors were examined.

Results: Population-level measurement was feasible for a subset of QIs, although several important limitations were identified. Documentation of performance status (PS) (45%) and multidisciplinary team discussion (36%) fell below benchmarks and rates in comparable health systems. Treatment safety and survival outcomes were comparable; however, variation was observed in adherence to treatment guidelines and timeliness indicators. Missing data were frequent for key clinical variables including PS (55.4%), stage (19.2%), and radiotherapy dose (25.6%). Missingness was non-random, limiting risk adjustment and interpretation of observed variation in care. QI compliance was consistently lower among older patients, those with poorer PS, lower socioeconomic status, and in rural or remote areas. Delays between care delivery, data availability and processing further limited the timeliness of reporting.

Conclusions: Routinely collected linked health data can support population-level assessment of lung cancer care and identify inequities in service delivery. However, incomplete data capture, non-random missingness and prolonged reporting delays limit its value as a quality improvement tool. Establishing a prospective, standardised lung cancer registry with structured data capture, interoperable information systems, and near real-time reporting would enable more timely, accurate and actionable quality measurement. In NSW, the implementation of the Single Patient Digital Record provides a unique opportunity to achieve this.