PROCARE, PROject on CAncer of the REctum Tamara Vandendael, on behalf of PROCARE BWGE 2011
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1 PROCARE, PROject on CAncer of the REctum Tamara Vandendael, on behalf of PROCARE BWGE 2011
2 PROCARE, PROject on CAncer of the REctum Introduction Description Results I. PROCARE Data Entry II. III. IV. Feedback TME-evaluation program PROCARE RX V. PROCARE RT Conclusion 2
3 Introduction PROCARE = PROject on CAncer of the REctum Multidisciplinary Belgian Project Launched in 2003 continues (at least) until summer 2012 Objective: Improve outcome in patients with rectal cancer by reducing diagnostic and therapeutic variability! Basis of PROCARE = prospective (online) registration! Continuous program on quality of care assessment 3
4 Surgery Radiotherapy Chemotherapy Pathology Radiology Material: photos, slices DATA ENTRY Description BOARD PATHOLOGY Revision Evidence Based Guidelines - Quality Indicators - Training BOARD SURGERY BSCRS BVRO ABRO Digestive Club Pathology College of Oncology RBRS BSMO, BGDO BOARD RADIOTHERAPY Revision BOARD RADIOLOGY
5 I. PROCARE data entry Cumulative Frequency of Registrations per Quarter Number of Registrations 4000 Paper Online
6 + Physicians from different disciplines and different hospitals can work together on 1 case + Easy and safe transfer of data + ehealth-services to create user access and to protect privacy of patients 6
7 I. PROCARE data entry 84/111 (76%) hospitals 3736 registrations (status on 31/01/2011) 89% Flanders 75% Brussels 55% Wallonia 7
8 II. Feedback Descriptive information, information on missing data and quality of care indicators Feedback report & definitions, graphs, survival curves Validation + analysis of patient data Once a year Teams with > 10 registrations: personal feedback General feedback results on 8
9 III. TME-evaluation program (1) What? Anonymous quality assessment of resected TME-specimens, pathological and surgical data How? 1) The BCR selects + collects the anonymous material Photos of the fresh specimen before inking (!) Photos of macro sections Micro slices Pathology Protocol PROCARE pathology checklist 2) The Pathology Board assesses the quality of the resected specimen on evaluable cases 3) The Surgery Board performs a final decision on the quality of the resected specimen and on adherence to guidelines Outcome of the review? Personal feedback on surgical and pathological aspects 9
10 III. TME-evaluation program (2) Phase 1: Candidate trainers 25 TME-trainers TME-teachings Phase 2: At random evaluation 252 cases (48%) prepared for the Pathology Board 84 (34%) evaluable Assess quality on resected specimen 71 (28%) non evaluable 525 cases selected 222 cases (42%) not reviewed because of incomplete material 97 (38%) not yet evaluated 51 cases (10%) not (yet) arrived at the BCR Photos of the fresh specimen before inking (!) status on 31/1/
11 IV. PROCARE RX What? Online radiology reviewing platform How? o o Ask for 2 nd opinion on ctn and clinical Circumferential Resection Margin (ccrm), based on CT- and/or MRI-images of the pelvis Expert radiologists review anonymously and at random if discordance: second and final review Review with anonymity of patient, radiologist, hospital and reviewer Status: only 18 cases (!) (status 31/01/2011) participation should be encouraged 11
12 V. PROCARE RT What? Online radiotherapy reviewing platform (Aquilab) Aim? Central review to homogenize the Clinical Target Volume (CTV) and organs-at-risk delineation of neoadjuvant irradiation Status: 18 hospitals participate, >300 cases reviewed 12
13 Surgery Radiotherapy Chemotherapy Pathology Radiology Material: photos, slices DATA ENTRY Conclusion BOARD PATHOLOGY Revision BOARD SURGERY Participate to this promising project! Evidence Based Guidelines - Quality Indicators - Training BSCRS BVRO ABRO Digestive Club Pathology College of Oncology RBRS BSMO, BGDO BOARD RADIOTHERAPY Revision BOARD RADIOLOGY
14 On behalf of PROCARE - Belgian Cancer Registry Koningsstraat / Rue Royale Brussel / Bruxelles Tel. 02 / Fax. 02 / tamara.vandendael@kankerregister.org
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