Concordance with national guidelines for colorectal cancer care in New South Wales: a population‐based patterns of care study

Abstract

Objective: To investigate predictors of evidence‐based surgical care in a population‐based sample of patients with newly diagnosed colorectal cancer. Design, patients and setting: Prospective audit of all new patients with colorectal cancer reported to the New South Wales Central Cancer Registry between 1 February 2000 and 31 January 2001. Main outcome measures: Concordance with seven guidelines from the 1999 Australian evidence‐based guidelines for colorectal cancer; predictors of guideline concordance; the mean proportion of relevant guidelines followed for individual patients. Results: Questionnaires were received for 3095 patients (91.6%). Between 0 and 100% of relevant guidelines were followed for individual patients (median, 67%). Concordance with individual guidelines varied considerably. Patient age independently predicted non‐concordance with guidelines for adjuvant therapy and preoperative radiotherapy. Adjuvant chemotherapy was more likely if a patient with node‐positive colon cancer was treated in a metropolitan hospital or by a general surgeon. Surgeons with a high caseload or specialty in colorectal cancer were more likely to perform colonic pouch reconstruction, prescribe thromboembolism or antibiotic prophylaxis, and were less likely to refer patients with high‐risk rectal cancer for adjuvant radiotherapy. Bowel preparation was less likely among older patients and in high‐caseload hospitals. Conclusion: Effective strategies to fully implement national colorectal cancer guidelines are needed. In particular, increasing the use of appropriate adjuvant therapy should be a priority, especially among older people.

Geographic remoteness, area-level socioeconomic disadvantage and inequalities in colorectal cancer survival in Queensland: a multilevel analysis

“…Geographical barriers and poorer health infrastructure [12] have previously been associated with lower receipt of multimodal therapies and lower survival of CRC patients in rural or (outer) regional Australia compared to major cities, [8,42,43] and, internationally, the impact on patient outcomes of variations in hospital volume and clinical experience are well-documented [44-46] in that higher caseloads and increased specialization generally improve CRC-related outcomes. All major centers of oncological care in Queensland are located in metropolitan areas and this is likely to be part of the explanation for the relatively better outcomes in major city and inner regional areas.…”

Clinician-led improvement in cancer care (CLICC) - testing a multifaceted implementation strategy to increase evidence-based prostate cancer care: phased randomised controlled trial - study protocol

“…The stepped wedge design is relatively insensitive to variations in the intracluster correlation (ICC) as a consequence of its efficient use of within-cluster and between-cluster information and has little impact on the study's power. However, based on the best available information, we estimate that the ICC for use of radiotherapy will be between 0.09 and 0.15 [72]. …”

Invited Commentary

“…18 A COI was an indicator of shortterm perioperative outcome that had been prospectively recorded and may reflect the standard of care, for example, total complication rate (wound infection, anastomotic leak, deep venous thrombosis, pulmonary embolism, cardiorespiratory complication, or death), anastomotic leak rate, and abdominoperineal excision (APE) rate for rectal cancer. These indicators were compared with the data available in the Colorectal Cancer Care Survey database and 16 indicators of care for which data were available were selected.…”