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.

Anatomy of Goal.target: measure, target value, due date — and the outcome On the left the episode goal with the three target elements measure (of what), detail (which value) and due (by when) as well as the achievementStatus; on the right the follow-up Observation providing the evidence, linked through outcomeReference. Below: measures are guideline-versioned, the old and the new measure coexist and are bound to their guideline source through relatedArtifact or instantiatesCanonical. Episode goal (Goal) with a measurable target measure — Of what? Disease status — LOINC 21976-6 detail — Which value? “no tumour detected” (Not detected) due — By when? Due date or target date achievementStatus: in-progress → achieved (state codes) Follow-up Observation “Not detected” LOINC 97509-4 · SCT 260415000 time-stamped, own reference point outcomeReference Outcome, one per goal Target value (intent) ≠ outcome (observation) — the target may be shared across goals, the outcome never is. Measures are guideline-versioned — old and new coexist: measure: DAS28 previous guideline measure: ACR-EULAR · SDAI/CDAI EULAR 2025 Guideline (version) relatedArtifact / instantiatesCanonical — provenance and validity “Remission by DAS28” ≠ “Remission by ACR-EULAR” — only the guideline reference makes parallel versions comparable. Goal / measure Observation Source / note Reference

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.