Colorectal Cancer Dashboard

Transcription

1 Process Risk Assessment Presence or absence of cancer in first-degree blood relatives documented for patients with colorectal cancer Percent of patients with colorectal cancer for whom presence or absence of cancer in first-degree relative was documented Measure 1 Presence or absence of cancer in second-degree blood relatives documented for patients with colorectal cancer Percent of patients with colorectal cancer for whom presence or absence of cancer in seconddegree relative was documented Measure 2 Age at diagnosis documented for each blood relative diagnosed with cancer Percent of patients with colorectal cancer for whom age at diagnosis of blood relative with cancer was documented Measure 3 Patients with invasive colorectal cancer referred for or received genetic testing Patients with increased hereditary risk referred for or received genetic testing Process Appropriateness of Care colorectal cancer who were referred for or received genetic testing colorectal cancer with increased hereditary risk for colon cancer who were referred for or received genetic testing ACoS/CoC 4, ASCO/QOPI 5 ACoS/CoC 6, ASCO/QOPI 7 Colon: Lymph node sampling Percent of surgical patients for which least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer National Average: 12 or more lymph nodes sampled in 41% 8-44% 9 of cases, Best Observed: 85% 10 ; ACoS/CoC CP3R Required Performance Rate: >80%, Ideal Benchmark: >90% 11 ACoS/RQRS 12, AMA-PCPI, ASCO/QOPI 13, NCCN 14, NQF # , PCHQR KRAS testing prior to administration of anti-egfr MoAb therapy Percent of patients with metastatic colorectal cancer tested for KRAS mutation prior to administration of anti-egfr MoAb therapy 30%-40% of metastatic colorectal cancers carry KRAS mutation 16 ; Ideal Benchmark: 100% ASCO/QOPI 17 Anti EGFR MoAb therapy received by patients with KRAS mutation Percent of patients with KRAS mutation who receive anti-egfr MoAb therapy Ideal Benchmark: 0% ASCO/QOPI Measure 18 Rectal: Adjuvant chemotherapy Percent of patients, <80 years of age, with stage II or III rectal cancer for whom post-operative adjuvant chemotherapy was considered or administered of eligible patients ASCO/QOPI 19, NCCN 20 Rectal: Post-operative radiation therapy Percent of patients, <80 years of age, with clinical or pathologic T4N0M0 or stage III rectal cancer receiving surgical resection for whom radiation therapy was considered or administered Ideal Benchmark:100% of eligible patients ACoS/RQRS 21, ASCO 22, NCCN 23 16

2 Process Appropriateness of Care Rate of sphincter-sparing surgery Multimodal therapy for rectal cancer Percent of rectal cancer patients receiving sphincter-sparing surgery Percent of stage II and III rectal cancer patients who received surgery, chemotherapy, and radiation National Average: 60.5% overall 24, Best observed in rectal cancers in lower third % 25, middle - 73%, upper third - 94% 26 ; Ideal benchmark: >70% overall NCDB Average: Stage II 55.8%, Stage III 61.3% 27 ASCO 28, NCCN 29 CEA within 4 months of curative resection for colorectal cancer Percent of patients receiving CEA monitoring within 4 months of curative colorectal cancer resection Measure 30 Colon: Adjuvant chemotherapy Percent of patients with stage III lymph node positive colon cancer, <80 years of age, for whom adjuvant chemotherapy was considered or administered within 4 months (120 days) of surgery National Average: 59% 31 ; of eligible patients 32 ACoS/RQRS 33, AMA-PCPI, ASCO/QOPI 34, NCCN 35, NQF # , PCHQR, PQRS Follow-up: Surveillance for cancer recurrence Percent of patients receiving colonoscopy within 6 months of curative colorectal cancer resection or adjuvant chemotherapy Average Performance: 49% after 14 months 37 ; Ideal Benchmark: >90% AGSE 38, ASCO/QOPI 39, NCCN Enrollment in clinical trials Percent of patients enrolled in clinical trials OR Percent of physicians referring one or more patients to trials per year Only 6% of colorectal cancer patients were aware that clinical trials existed 40. Average percent of physicians referring one or more patients to a clinical trial: medical oncology - 88%, radiation oncology - 66%, surgical oncology - 35% 41 ; CoC Requirement: 4% of all analytic cases across all tumor sites, Ideal Benchmark for patient enrollment: >10% enrollment, Ideal Benchmark for physician participation: 100% of physicians refer 1 or more patients ACoS/CoC 42 Process Patient-Centered Care Pre-test genetic counseling colorectal cancer who were referred for or received pre-test genetic counseling as per ACoS/CoC 2012 Standards 43 ACoS/CoC 44 Post-test genetic counseling colorectal cancer who were referred for or received post-test genetic counseling as per ACoS/CoC 2012 Standards 45 ACoS/CoC 46, ASCO/QOPI 47 17

3 Process Patient-Centered Care Shared decision-making Percent of patients sharing in decision-making regarding surgical options Reported Average: 34% 48 ; of patients who desire an active role in decisionmaking Process Documentation Completeness Colorectal: Pathology report completeness Percent of pathology reports containing all data elements specified by CAP surgical case summary CAP Quality Probe average: 65.7% of colorectal pathology reports complete 49 ; ACoS/CoC Requirement: 90% of pathology reports include required data elements as per CAP protocol 50, Ideal benchmark: 100% ACoS/CoC 51, ASCO/QOPI 52, CAP 53 Colorectal: Staging completeness Percent of patients with complete TNM staging documented in the medical record Reported Averages: 38%- 73% TNM staging completeness 54 ; ACoS/CoC Requirement: 90% of pathology reports include required data elements as per CAP protocol (staging included) 55, Ideal benchmark: 100% ACoS/CoC 56, ASCO/QOPI 57, CAP 58 Outcome Rectal: Surgical margin positivity rate Percent of rectal cancer patients with positive surgical margins Upper middle rectal: 12.6% 59, Low rectal overall: 20% % 61, Low rectal abdominalperineal excision: 30.4% % 63, Low rectal anterior resection 10.7% 64-12% 65 ; Ideal Benchmark: <11% 66 Colon: Surgical margin positivity rate Percent of colon cancer patients with positive surgical margins Best Observed: 11% 67 Anastomotic leaks Percent of surgical patients experiencing anastomotic leak Average: Rectal 3% 68-10% 69, Colon 3% 70 ; Ideal Benchmark: Rectal <5%, Colon <3% Local recurrence rate Percent of patients with locally recurrent cancer within 5-years Average: Colon cancer 18% depending on stage and therapy 71, Rectal cancer: 2-30% depending on stage and therapy (e.g. Local recurrence after mesorectal excision and radiotherapy: 2.4%, Mesorectal excision alone: 8.2%) 72 18

4 Outcome Survival rate: Colon Five-year survival rate by stage at diagnosis All stages 63.6% Localized 90.8% Regional 70.0% Distant 11.7% Unstaged 27.4% By Stage: Stage I - 74% Stage IIA - 67% Stage IIB - 59% Stage IIC - 37% Stage IIIA - 73% Stage IIIB - 46% Stage IIIC - 28% Stave IV - 6% 73 ASCO/QOPI 74 Survival rate: Rectal Five-year survival rate by stage at diagnosis All stages 66.2% Localized 88.0% Regional 68.5% Distant 12.7% Unstaged 45.4% By Stage: Stage I - 74% Stage IIA - 65% Stage IIB - 52% Stage IIC - 32% Stage IIIA - 74% Stage IIIB - 45% Stage IIIC - 33% 75 ASCO/QOPI 76 19

5 Sources 1-3,5,7,13,22,28,39,47,52,57,74,76. American Society of Clinical Oncology, Quality oncology practice initiative: Summary of measures, Spring 2012, available at: pdf, last accessed: August ,6,12,21,33,42,43-46,50,51,55,56. American College of Surgeons, Cancer program standards 2012: Ensuring patient-centered care, 2011, available at: last accessed: August Storli KE, et al., "Overall survival after resection for colon cancer in a national cohort study was adversely affected by TNM stage, lymph node ratio, gender, and old age, International Journal of Colorectal Disease, 2011, 26(10): Baxter NN, et al., "Lymph node evaluation in colorectal cancer patients: A population-based study," Journal of the National Cancer Institute, 2005, 97(3): Stocchi L, et al., Individual surgeon, pathologist, and other factors affecting lymph node harvest in stage II colon carcinoma. Is a minimum of 12 examined lymph nodes sufficient?" Annals of Surgical Oncology, 2011, 18(2): Vather R, et al., "Lymph node evaluation and long-term survival in stage II and stage III colon cancer: A national study, Annals of Surgical Oncology, 2009, 16(3): ,19,29,35. ASCO/NCCN Quality measures: Breast and colorectal cancers, Alexandria (VA): American Society of Clinical Oncology, National Comprehensive Cancer Network, Inc, National Quality Forum, NQF Endorsed Measure #0225, At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer, available at: last accessed: June 20, College of American Pathologists. "KRAS mutation testing for colorectal cancer (CRC)," 2010, published online at: =%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cnt vwrptlt%7bactionform.contentreference%7d=committees%2ftechnolog y%2fkras_mutation.html&_state=maximized&_pagelabel=cntvwr 17,18. Allegra CJ, et al., "American society of clinical oncology provisional clinical opinion: Testing for KRAS gene mutations in patients with metastatic colorectal carcinoma to predict response to anti-epidermal growth factor receptor monoclonal antibody therapy," Journal of Clinical Oncology, 2009, 27(12): ; Brand TM, Wheeler DL, "KRAS mutant colorectal tumors: Past and present, Small GTPases, 2012, 3(1): ,23. National Comprehensive Cancer Network, National comprehensive cancer network clinical practice guidelines: Rectal cancer, 2010, available at: last accessed August, Paquette IM, et al., "Patient and hospital factors associated with use of sphincter-sparing surgery for rectal cancer," Diseases of the Colon and Rectum, 2010, 53(2): , available at: ital_factors_associated_with_use.2.aspx 25. Elwanis MA, et al.. Surgical treatment for locally advanced lower third rectal cancer after neoadjuvent chemoradiation with capecitabine: prospective phase II trial, World Journal of Surgical Oncology, 2009, 7(52): NP. 26. Di Betta E, et al., "Sphincter saving rectum resection is the standard procedure for low rectal cancer," International Journal of Colorectal Disease, 2003, 18(6): National Cancer Database (NCDB) Benchmark Reports, NCDB Analytic Cases: Rectal Cancer, Diagnosis Year 2009, First course treatment surgery, chemotherapy, radiation, United States, available at: American Society of Clinical Oncology, 2005 Update of ASCO practice guideline recommendations for colorectal cancer surveillance: Guideline summary, 2005, available at: last accessed: August Rayson D., et al., Clinical practice guidelines (CPGs) for adjuvant chemotherapy (act) in colorectal cancer: A population-based analysis of adherence and non-receipt, Journal of Clinical Oncology, 2011, National Quality Forum, NQF Endorsed Measure #0223, Adjuvant chemotherapy is considered or administered within 4 months (120 days) of surgery to patients under the age of 80 with AJCC III (lymph node positive) colon cancer, available at: last accessed: June 20, 2012; Benson AB 3rd, et al., "American society of clinical oncology recommendations on adjuvant chemotherapy for stage II colon cancer," Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 2004, 22(16): Benson AB 3rd, et al., "American society of clinical oncology recommendations on adjuvant chemotherapy for stage II colon cancer," Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 2004, 22(16): National Quality Forum, NQF Endorsed Measure #0223 Adjuvant chemotherapy is considered or administered within 4 months (120 days) of surgery to patients under the age of 80 with AJCC III (lymph node positive) colon cancer, available at: last accessed: June 20, Salz T, et al., Variation in use of surveillance colonoscopy among colorectal cancer survivors in the United States, BMC Health Services Research, 2010, Available at: last accessed: August Davila RE et al., "ASGE guideline: Colorectal cancer screening and surveillance, Gastrointestinal Endoscopy, 2006, 63(4):

6 Sources 40. Coalition of Cancer Cooperative Groups, Cancer clinical trials awareness and attitudes in cancer survivors, Spring 2006, available at: Mode=19, last accessed: August Few physicians refer patients to cancer clinical trials, Journal of the National Cancer Institute, 2011, 103 (5): NP, available at: Leon-Carlyle M, et al., "Using patient and physician perspectives to develop a shared decision-making framework for colorectal cancer". Implementation Science, 2009, available at: 26(3): Davila RE, et al., "ASGE guideline: Colorectal cancer screening and surveillance," Gastrointestinal Endoscopy, 2006, 63(4): ,75. Howlader N, et al., SEER cancer statistics review, (Vintage 2009 Populations), Bethesda (MD): National Cancer Institute., 2012, available at: last accessed: June ,53,58. Idowu MO, et al., "Adequacy of surgical pathology reporting of cancer: A college of American pathologists q-probes study of 86 institutions," Archives of Pathology and Laboratory Medicine, 2012, 134(7): Abernethy AP, et al., Poor documentation prevents adequate assessment of quality metrics in colorectal cancer, Journal of Oncology Practice, 2009, 5(4): ,61,62,64. Nagtegaal ID, et al., "Low rectal cancer: a call for a change of approach in abdominoperineal resection, Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 2005, 23(36): ,63,65. Shihab OC, et al., "Patients with low rectal cancer treated by abdominoperineal excision have worse tumors and higher involved margin rates compared with patients treated by anterior resection," Diseases of the Colon and Rectum, 2010, 53(1): Salem Health, GI Committee: Clinical dashboards, 2011, available at: last accessed: September Birbeck KF, et al., Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery, Annals of Surgery, 2002, 235(4):449-57; Rullier E, et al., sphincter-saving resection for all rectal carcinomas: The end of the 2-cm distal rule, Annals of Surgery, 2005, 241(3):465-9; Kane et al, Controversies in the surgical management of rectal cancer, Seminars in Radiation Oncology, 2003, 13(4): Smith JD, "Anastomotic leak is not associated with oncologic outcome in patients undergoing low anterior resection for rectal cancer, Annals of Surgery, 2012, Epub ahead of print, available at: last accessed: July Phillips BR, et al. "Anastomotic leak rate after low anterior resection for rectal cancer after chemoradiation therapy," American Surgeon, 2010, 76(8): Hyman N, et al., Anastomotic leaks after intestinal anastomosis: It's later than you think, Annals of Surgery, 2007, 245(2): ; Isbister WH, "Anastomotic leak in colorectal surgery: A single surgeon's experience," The Australian and New Zealand Journal of Surgery, 2001, 71(9): Weiser MR, et al., "Individualized prediction of colon cancer recurrence using a nomogram," Journal of Clinical Oncology, 2008, 21