Implementierungsleitfaden Therapieziele Onkologie
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Zielwerte und Messgrößen

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A therapy goal becomes measurable through targets. FHIR Goal.target has three parts: target.measure (the tracked parameter, coded, e.g. LOINC/SNOMED), target.detail (the intended value/range) and target.due (the deadline). A goal may carry several targets.

Anatomie des Goal.target: Messgröße, Zielwert, Frist — und das Ergebnis Links das Episodenziel mit den drei target-Elementen measure (woran), detail (welcher Wert) und due (bis wann) sowie dem achievementStatus; rechts die evidenzierende Verlaufs-Observation, verbunden ueber outcomeReference. Unten: Messgroessen sind leitlinienversioniert, alte und neue Groesse koexistieren und werden ueber relatedArtifact bzw. instantiatesCanonical an ihre Leitlinienquelle gebunden. Episodenziel (Goal) mit messbarem target measure — Woran? Krankheitsstatus — LOINC 21976-6 detail — Welcher Wert? „kein Tumornachweis“ (Not detected) due — Bis wann? Frist bzw. Zieltermin achievementStatus: in-progress → achieved (Zustands-Codes) Verlaufs-Observation „Not detected“ LOINC 97509-4 · SCT 260415000 zeitgestempelt, Bezugspunkt selbst definiert outcomeReference Ergebnis, pro Ziel eigen Zielwert (Absicht) ≠ Ergebnis (Beobachtung) — der target darf über Ziele gleich sein, das Ergebnis wird nie geteilt. Messgrößen sind leitlinienversioniert — Alt und Neu koexistieren: measure: DAS28 Leitlinienstand alt measure: ACR-EULAR · SDAI/CDAI EULAR 2025 Leitlinie (Version) relatedArtifact / instantiatesCanonical — Herkunft und Gültigkeit „Remission nach DAS28“ ≠ „Remission nach ACR-EULAR“ — erst der Leitlinienbezug macht parallele Stände vergleichbar. Ziel / Messgröße Beobachtung Quelle / Hinweis Referenz

Mainly at the level of therapy episodes

This measurable target logic applies mainly to the episode goals of the individual therapy episodes (concrete parameters: disease status, staging, response …). The overarching goal, by contrast, usually carries no measurable target but the strategic intent (curative vs. palliative) — a clinical judgement depending on the cancer entity and the staging/grading threshold at which curative treatment (e.g. resectability) is no longer possible.

Target ≠ outcome; trajectory lives in the observation

Goal.target is the intended value (and may be shared across goals); Goal.outcomeReference is the observed result — one per goal, empty until observed. achievementStatus uses state codes only (in-progress, achieved, not-achieved, not-attainable); the trajectory (response over time) lives in the outcome Observations (RECIST, mCODE Cancer Disease Status), which are timestamped and define their own reference point.

A modality is not an endpoint

Not every clinical procedure is a suitable target. A follow-up mammography is a means of assessment, not an endpoint — the endpoint is the disease/recurrence status; the mammography belongs in a ServiceRequest, not in target.measure.

Typical measures (general)

These measures are general, not scenario-specific; some are entity-specific (e.g. ER/PR/HER2 in breast cancer), others general (TNM, stage group, disease status). Examples: tumour size (max. dimension, LOINC 33728-7), residual-tumour status R0/R1/R2 (84892-9), leukocytes for leukopenia (6690-2), and tumour markers in monitoring — PSA (2857-1), CA-125 (ovarian, 10334-1), CEA (2039-6), CA 15-3 (breast, 6875-9). Tumour-marker use is entity- and situation-dependent: CA-125 is an established monitoring endpoint in ovarian cancer (GCIG criteria), whereas routine CA 15-3 in asymptomatic curative breast follow-up is not guideline-recommended.