Improving quality of care and clinical outcomes for rectal cancer through clinical audits in a multicentre cancer care organisation

Abstract

Introduction: Colorectal cancer treatment requires a complex, multidisciplinary approach. Because of the potential variability, monitoring through clinical audits is advisable. This study assesses the effects of a quality improvement action plan in patients with locally advanced rectal cancer and treated with radiotherapy. Methods: Comparative, multicentre study in two cohorts of 120 patients each, selected randomly from patients diagnosed with rectal cancer who had initiated radiotherapy with a curative intent. Based on the results from a baseline clinical audit in 2013, a quality improvement action plan was designed and implemented; a second audit in 2017 evaluated its impact. Results: Standardised information was present on 77.5% of the magnetic resonance imaging (MRI) staging reports. Treatment strategies were similar in all three study centres. Of the patients whose treatment was interrupted, just 9.7% received a compensation dose. There was an increase in MRI re-staging from 32.5 to 61.5%, and a significant decrease in unreported circumferential resection margins following neoadjuvant therapy (ypCRM), from 34.5 to 5.6% (p < 0.001). Conclusions: The comparison between two clinical audits showed improvements in neoadjuvant radiotherapy in rectal cancer patients. Some indicators reveal areas in need of additional efforts, for example to reduce the overall treatment time.

Differences in survival and recurrence of colorectal cancer by stage across population‐based European registries

“…After adjustment for sex, age and cancer location, there were slight differences in recurrence rates among countries. In rectal cancer, the state of the circumferential resection margin after neoadjuvant treatment 20 and the total mesorectum excision are associated to the recurrence rate, 21 but it is possible that the proportion of patients who benefited from the technique varied by country. It is sometimes difficult for clinicians and pathologists to differentiate a cancer recurrence from a second primary colorectal cancer, so that misclassifications may exist and differ between countries, even with common coding rules.…”