Early mortality after chemotherapy as a quality indicator—the leukemia perspective

The early mortality rate after a medical procedure or treatment has been a historical measure of quality of care delivery. It was originally developed to assess the risk of surgeries or other procedures and later adopted across medical practices to evaluate differential risks of early mortality with similar therapies to define favorable or unfavorable outliers, and to improve delivery of care. Its subsequent adoption in cancer care had broad applications in areas with widely divergent environments and influencing factors. Some of the variables include the kind of tumor (solid tumor or liquid tumor [leukemia, myeloma, lymphoma]); the type of surgery (extremes of Whipple procedure or lymph node biopsy); the stage (early or advanced); the treatment intensity (intensive chemotherapy, lower-intensity therapy, stem cell transplantation, targeted therapy, immunotherapy); and the risk of mortality with intensive chemotherapy (compromised bone marrow in leukemia or intact bone marrow reserve in solid tumors) [ 1 , 2 ].