7/29/2014. Patterns of Care in Colon Cancer ( ) Literature. Background. Florida Cancer Data Compliance with NCCN Guidelines

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1 Patterns of Care in Colon Cancer (21-212) Florida Cancer Data Compliance with FCDS Annual Meeting July 24-25, 214 Caribe Royale Resort Orlando, Florida Background O NCCN guidelines are referenced extensively O Cancer conferences O Recent CER project for FCDS O Guidelines reviewed regularly O Provide benchmark for treatment compliance Literature O Patterns of care studies done at many levels O Benchmark study in 29 by CDC/NPCR O Examined compliance with chemotherapy guidelines for colon cancer patients O Results of the study showed variance for compliance based on many factors 1

2 The FCDS Experience O FCDS data analysis for NCCN guideline compliance O Colon cancer patients for 21, 211, and 212 O Results shared first internally for review and discussion Goals O Capture baseline treatment patterns for colon cancer from FCDS data O Analyze treatment delivered to assess compliance with NCCN guidelines O Describe treatment by demographic and comorbid status O Identify areas for targeted quality control review Methods O Select 21, 211, and 212 colon cancer cases in FCDS database using defined inclusion criteria O Separate cases by AJCC group stage O Analyze each stage group s cases according to recommended treatment for that stage as defined by NCCN guidelines O Treatments reviewed included surgery, chemotherapy, and radiation O Elixhauser comorbidity index created from AHCA O Computer algorithm developed to process cases 2

3 Methods Methods Methods O Program written in SAS statistical software to group data for analysis using standard NAACCR variables 3

4 Data Elements Primary Site Central Sequence Age at Diagnosis Diagnosis Date Morphology ICD3 Behavior ICD3 Surgical Treatment Scope Surgery Reason No Surgery Radiation Treatment Reason No Radiation Chemo Treatment Hormone Treatment BRM Therapy Regional Nodes Positive Regional Nodes Examined Surgery Radiation Sequence Systemic Surgery Sequence Derived AJCC Stage 7th ed. Comorbidity Index Inclusion Criteria O Primary site: C18., C C18.9 O Histology: , , , , , , O Behavior: 2 and 3 O Diagnosis years: O Resident of Florida at time of Diagnosis O AHCA linkage years: 21 and 211 O Analytic cases only 3 Case Distribution Percentage by Stage Colon Cancer 5 4

5 Case Distribution Percentages by Age Group <5 y.o >75 Comorbidities None 1 to 5 >5 Results O Results of treatment compliance with guidelines were analyzed by disease stage O Detailed analysis of treatment by age group and comorbidities is included for each stage O Cases where the patient died prior to therapy, patients who had therapy offered but refused therapy, and those cases where therapy was contraindicated, are included in cases meeting guideline criteria 5

6 Findings: Insitu Cancers Average Unknown Does Not Meet Meets Guidelines Findings: Insitu Cancers Percentage of patients who follow guidelines by Age Group < >75 Unknown Does Not Meet Meets Guidelines Stage I O Surgery Resection with 12 or more lymph nodes removed O NO adjuvant therapy Findings O 89% of patients had surgery that followed guidelines O 62% met guidelines for having 12 or more lymph nodes removed O Another 25% of patients had 1-11 nodes removed O Patients with no comorbidities had slightly higher percentage of meeting guidelines both for surgery and for lymph nodes removed O A higher percentage of younger patients met recommended guidelines for lymph nodes than did older patients 6

7 Findings: Stage I Percentage of patients who follow guidelines for nodes removed by age group <5 y.o >75 Average Unknown 1 1 No nodes nodes >12 nodes Stage IIA O Surgery resection with 12 or more lymph nodes removed O Consider chemotherapy especially for high risk features Findings O 99% of patients received surgery by recommended guidelines O 82% had the recommended 12 or more LN removed O Patients with fewer comorbidities were more likely to have the recommended number of nodes removed Findings: Stage IIA Percentage of patients who follow guidelines for nodes removed by comorbid status No 1-5 >5 Comorbidities Comorbidities Comorbidities Average Unknown No nodes nodes >12 nodes

8 Stage IIB/C O Surgery resection with 12 or more lymph nodes removed O Consider neoadjuvant chemotherapy/xrt as appropriate O Consider adjuvant chemotherapy/radiation Findings O 96 % received recommended surgery per guidelines O Only 27% received chemotherapy under recommendation to consider chemotherapy O Of this 27%, 93% received adjuvant chemotherapy Stage III O Surgery resection with 12 or more lymph nodes removed O Adjuvant chemotherapy Findings O 99% of patients received surgery as recommended by NCCN guidelines O Overall 52% of stage III patients have documentation showing compliance with recommended guidelines for chemotherapy administration O Younger patients (<5 yo) had higher percentages of chemotherapy administration than older patients (> 75 yo), 68% compared to 38% Findings: Stage III Percentage of patients who follow guidelines for chemotherapy by age group <5 y.o >75 Average Unknown Does Not Meet Meets Guidelines

9 O Stage IV Stage IV guidelines contain a selection of treatment options for the patient O Surgical resection O Chemotherapy neoadjuvant, adjuvant,or as primary O Radiation Findings O 49% of stage IV patients received chemotherapy, with 61% of this group receiving adjuvant treatment and 32% having chemotherapy as their primary treatment mode O 81% of patients did not receive cancer directed surgery O There were no clear trends for surgery by comorbid status O Younger patients had higher percentages both for surgery and for chemotherapy administration Findings: Stage IV Percentage of patients who received surgery Unknown if Surgery 1 No Surgery Surgery Summary O Compliance with NCCN guidelines varied by stage O Compliance affected by multiple factors O Results are impacted by data capture limits O Future work could use NCCN guidelines as the basis for quality control studies O Future analysis to include physician reported cases for comparative analysis 9

10 References O National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Colon Cancer. Version O National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Colon Cancer. Version O Boland GM, Chang GJ, Haynes AB, et al. Association between adherence to national comprehensive cancer network treatment guidelines and improved survival in patients with colon cancer. Cancer. 213;119(8): O Cress, RD, Sabatino, SA, Wu, XC, et al. Adjuvant chemotherapy for patients with stage III colon cancer: Results from a CDC-NPCR patterns of care study. Clinical Medicine: Oncology. 29(3): O El Shayeb M, Scarfe A, Yasui Y, Winget M. Reasons physicians do not recommend and patients refuse adjuvant chemotherapy for stage III colon cancer: A population based chart review. BMC research notes. 212;5:269. O Mallin K, Palis BE, Watroba N, et al. Completeness of american cancer registry treatment data: Implications for quality of care research. J Am Coll Surg. 213;216(3): O O Grady, MA, Slater, E, Sigurdson, ER, et al. Assessing compliance with national comprehensive cancer network guidelines for elderly patients with stage III colon cancer: The fox chase cancer center patrtners initiative. Clin Colorectal Cancer. 211; 1(2):