Quality indicators for colorectal cancer surgery and care according to patient-, tumor-, and hospital-related factors

Abstract

BackgroundColorectal cancer (CRC) care has improved considerably, particularly since the implementation of a quality of care program centered on national evidence-based guidelines. Formal quality assessment is however still needed. The aim of this research was to identify factors associated with practice variation in CRC patient care.MethodsCRC patients identified from all cancer centers in South-West France were included. We investigated variations in practices (from diagnosis to surgery), and compliance with recommended guidelines for colon and rectal cancer. We identified factors associated with three colon cancer practice variations potentially linked to better survival: examination of ≥12 lymph nodes (LN), non-use and use of adjuvant chemotherapy for stage II and stage III patients, respectively.ResultsWe included 1,206 patients, 825 (68%) with colon and 381 (32%) with rectal cancer, from 53 hospitals. Compliance was high for resection, pathology report, LN examination, and chemotherapy use for stage III patients. In colon cancer, 26% of stage II patients received adjuvant chemotherapy and 71% of stage III patients. 84% of stage US T3T4 rectal cancer patients received pre-operative radiotherapy. In colon cancer, factors associated with examination of ≥12 LNs were: lower ECOG score, advanced stage and larger hospital volume; factors negatively associated were: left sided tumor location and one hospital district. Use of chemotherapy in stage II patients was associated with younger age, advanced stage, emergency setting and care structure (private and location); whereas under-use in stage III patients was associated with advanced age, presence of comorbidities and private hospitals.ConclusionsAlthough some changes in practices may have occurred since this observational study, these findings represent the most recent report on practices in CRC in this region, and offer a useful methodological approach for assessing quality of care. Guideline compliance was high, although some organizational factors such as hospital size or location influence practice variation. These factors should be the focus of any future guideline implementation.

Surgery for Colorectal Cancer in Sri Lanka: Open to Laparoscopy

“…The overall operability among our patients (90 %) was lower than other studies (97 %) [19]. However, the operability among those patients undergoing emergency procedures was only 65 %, a finding that has not been reported earlier.…”

“…Eighty percent of deaths followed surgery for rectal cancer. Mortality as high as 13% has been reported following emergency procedures while that reported for elective procedures is around 2% [19]. In these studies it is not clear if post-operative mortality was procedure related or due to other co morbid factors.…”

“…Similarly, the overall incidence of anastomotic dehiscence (3.7% in this study) ranged between 1% to 30% in the literature [24,25]. Higher incidences of anastomotic dehiscence have been reported following rectal cancer resection versus colon resection (5% vs. 10%) [19]. However in the hands of an experienced colorectal surgeon, the reported incidence of years (median 1.1 years).…”

“…The use of neoadjuvant chemoirradiation for RC became the standard practice after the trial in 2012 [19,20]. Though 49 % patients with RC received neoadjuvant therapy sub group analysis shows a marked increase in the tendency to use neoadjuvant therapy after the year 2011 (27% before and 80 % after 2011).…”

Measuring Concordance with Guidelines for the Diagnosis and Treatment of Colon Cancer

“…A strong decrease in guideline concordance related to patient age was evident, with the adjuvant chemotherapy rate dropping from 90% for patients less than 60 years of age to 20% for patients 80 years of age and older (data not shown). A French study conducted in 2002-2003 found that, after controls for other possible factors had been applied, the use of chemotherapy dropped significantly for patients 75 years of age and older 8 .…”