2009 Cancer Committee

Transcription

1 2009 Cancer Committee Colon Cancer Study Stages I-lV Joseph Carmichael, M.D. Alicia Stark, RHIT Jeff Robinson

2 Table of Cont ent s Table of Contents... 1 Colon Cancer Facts.. 2 CoxHealth Cancer Committee Study Criteria Item I Patients Diagnosed. 4 Item II Age Distribution Item III Diagnostic Exams Item Treatment Modalities Item V Laparoscopic vs. Open Colectomy 7 Item VI Lymph Node Evaluation...7 Item VII Survival Rates Conclusion.. 10

3 Colon Cancer Facts: Not counting skin cancers, colorectal cancer is the third most common cancer found in men and women in this country. The risk of a person having colorectal cancer in their lifetime is about 1 in 19. Three standard colon cancer treatment options include surgery, chemotherapy, and radiation therapy. Surgery is the most common treatment for all stages of colon cancer. Colon cancers are more common in people over 50, and the risk increases with age. In the United States it is estimated that in 2009 there will 106,100 new cases of colon cancer. An estimated 49,920 people will die this year from colorectal cancer in the United States. 2

4 Colon Cancer Study Criteria: CoxHealth Cancer Committee In 2009, the Hulston Cancer Committee elected to conduct an outcome and survival analysis of our Stage I-lV Colon Cancer Patients. This study focused upon patients with an initial diagnosis between the time periods of (see criteria below). Members voted unanimously to approve the Colon Cancer study as outlined. Criteria: Study: All patients diagnosed in the years with Colon Cancer in Stage I, diagnostic exams performed prior to treatment, treatment modalities and five year survival. I. Evaluate how many patients were diagnosed with colon cancer. II. Evaluate at what age the patients were diagnosed. III. Identify what percentage of the patients had a pretreatment CT, colonoscopy or barium enema, PET and CEA.. Identify the percentage of patients having surgery, radiation or chemotherapy alone or combination Surg/Rad, Surg/Chemo, Rad/Chemo or Surg/Rad/Chemo. V. Evaluate Laparoscopic verses Open Colectomy. VI. Evaluate lymph node resection of less than twelve nodes verses greater than twelve. If less than twelve, what percent were located in the area of the splenic flexure. VII. Evaluate the 5 year survival rate and benchmark to national data resources. 3

5 2009 Colon Cancer Study Details: Item I -- Patients Diagnosed with Colon Cancer During the years 1999 through 2003, 481 patients were diagnosed with colon cancers in Stages I-. Of those 481 patients, 79 had other cancers in addition to colon cancer. These 79 patients were excluded, leaving 402 patients for our study. Item II Age Distribution at Time of Diagnosis Of the 402 patients studied, the most common age at diagnosis was the age group. (See Figure 1 Below) Average Age for Cox Study Group All Stages % 25.00% 25.87% 24.88% 20.00% 20.40% 15.00% 14.93% 10.00% 7.96% 5.00% 0.00% 2.99% 2.24% 0.75% Age Groups Figure 1 Average Age (Source: CoxHealth Cancer Registry Database) 4

6 Item III Pretreatment Diagnostic Procedures In 2003, 70 patients were diagnosed with stage l-lv colon cancer. Of these 70 patients all received a pretreatment diagnostic procedure patients had CT 8 patients had PET 64 patients had Colonoscopy or BE 55 patients had CEA In 2007, 69 patients were diagnosed with stage l-lv colon cancer. Of these 69 patients 68 received a pretreatment diagnostic procedure. One patient refused all diagnostic testing. (See Figure 2 Below) patients had CT 4 patients had PET 56 patients had Colonoscopy or BE 49 patients had CEA Colon Stages I vs Preoperative Exams 100% 90% 80% 70% 60% 50% 40% 58% 74% 90% 81% 79% 71% % 20% 10% 11% 6% 0% CT PET COLONSCOPY OR BE CEA Exam Figure 2 Preoperative Exam 2003 vs (Source: CoxHealth Cancer Registry Database) 5

7 Item Treatment Options Of the 402 patients in our study, 233 patients had surgery only None had radiation only 9 had chemotherapy only and all were stage lv 4 had combination surgery/radiation 117 had surgery/chemo 25 had surgery/radiation/chemo 1 had radiation/chemo 13 had no treatment and all were stage lv. 6 - Patient chose Hospice/Comfort care only 3 - Not candidates for treatment 2 - Patient refused treatment 2 - Patient expired before treatment Colon Stage I- Cox Treatment Options by Stage I II III I II III II II III I I I I II III II III I I II III I II III S R C S/R S/C S/R/C R/C I II III III Patient Treatment Options II III NO TREATMENT Figure 3 Treatment Options by Stage (Source: CoxHealth Cancer Registry Database) 6

8 Item V Laparoscopic vs. Open Colectomy Of the 402 patients in our study, 361 were open colectomy cases 5 were laparoscopic cases 20 did not have any surgery 13 had surgery elsewhere 3 had polypectomy Item VI Lymph Node Removal Of the 361 open colectomy cases for 1999 through 2003, 120 had a resection with greater than 12 nodes pathologically examined 17 had a resection of exactly 12 nodes pathologically examined 224 had a resection of less than 12 nodes pathologically examined o 44 patients or 17% of the 224 patients that had a LUQ resection where less than 12 nodes were pathologically examined. In 2007 the National Comprehensive Cancer Network (NCCN) recommended, that at least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer. We chose to look at our adoption rate for this more recent NCCN guideline by comparing our pre-guideline 1999 through 2003 lymph node evaluation to post-guideline data for our 2008 colectomy cases data shows significant improvement within our facility as shown below. Of the 63 open colectomy cases in 2008, 60 had greater than 12 nodes pathologically examined 1 had exactly 12 nodes pathologically examined 2 had less than 12 nodes pathologically examined Neither case was a LUQ procedure 7

9 The percentage of colectomy patients for whom at least 12 regional lymph nodes are removed and pathologically examined are: 40% for % for 2008 Item VII Survival Rates For comparison to the Cancer Information Reference File (CIRF) national data, we were limited to the time period of 1999 to 2002 due to the unavailability of 2003 patient data by our software vendor. For this adjusted time period, at CoxHealth, 332 stage I-lV colon cancer patients were diagnosed. These 332 patients have been followed and are now compared to the CIRF National Database which is comprised of 40,687 patients with stage I-lV colon cancer. (See Figure 4 Below) COLON SURVAL - COX VS. CIRF/National COX STAGE I NATIONAL STAGE I COX STAGE II NATIONAL STAGE II COX STAGE III NATIONAL STAGE III COX STAGE NATIONAL STAGE COX STAGE I NATIONAL STAGE I COX STAGE II NATIONAL STAGE II COX STAGE III NATIONAL STAGE III COX STAGE NATIONAL STAGE MONTHS Figure 4 Colon Survival Cox vs. CIRF (Source: CoxHealth Cancer Registry Database) (Please note CIRF survival data is for ) 8

10 For comparison to the National Cancer Data Base (NCDB) we were limited to the time period of 1998 to CoxHealth diagnosed 307 patients with stage I-lV colon cancer during this time period. These 307 patients have been followed and compared to the NCDB data comprised of 195,461 patients. (See Figure 5 Below) Cox/NCDB Comparative Survival Colon Stage I- 5 yr Cox Stage I National Stage I Cox Stage II National Stage II Cox Stage III National Stage III Cox Stage National Stage 20 0 Dx 1 Year 2 Year s 3 Year s 4 Year s 5 Year s Cox Stage I National Stage I Cox Stage II National Stage II Cox Stage III National Stage III Cox Stage National Stage Figure 5 Cox/NCDB Comparative Survival (Source: CoxHealth Cancer Registry Database) (Please note that NCDB survival data is for ) 9

11 Conclusion: I. During the years 1999 through 2003, 481 patients were diagnosed at CoxHealth with colon cancer. 79 patients had other cancers in addition to colon cancer. II. Patients diagnosed with colon cancer were predominantly between the ages of 60 and 89 (71%). Slightly more than one half (51%), of the colon cancers occurred in patients aged 60 to 79 years. III. Of the 402 patients in this study, 3% received no specific therapy after diagnosis.. 87% of patients were treated with surgery alone or surgery with chemotherapy. V. Our study demonstrated that 40% of patients with colectomy had 12 or more lymph nodes that were pathologically examined in the specimen. A review of data in 2008 demonstrated that 97% of our patients with colectomy had 12 or more lymph nodes that were pathologically examined in the specimen. This demonstrates a strong adherence to NCCN guidelines for resection/evaluation of lymph nodes. The marked increase in the percent greater than 12 nodes examined is felt to be related to new methods used in identifying lymph nodes in the Pathology Department. VI.. CoxHealth s five year survival rate is comparable the national survival rate. 10

12 Works Cited: a. American Cancer Society b. Medline Plus c. National Cancer Institute 11

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