Shore Medical Center Site-Specific Study: Colorectal Cancer 2013

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1 Shore Medical Center Site-Specific Study: Colorectal Cancer

2 Shore Medical Center Site-Specific Study: Colorectal Cancer The following report is the result of a collaborative effort of four physician members of the Cancer Committee: James Pond, MD, Pathologist, Julianne Childs, DO, Medical Oncologist, David May, MD, General Surgeon, and Hemangini Shah, DO, Radiation Oncologist, with Cancer Registry data provided by Michelle Bob, RHIT, CTR. Although the raw data has not been subjected to statistical analysis, the following data is being presented per the recommendations of the Commission on Cancer. Forty-seven analytic invasive colorectal cancer cases diagnosed and/or treated at for the year were reviewed to assess whether patients at were evaluated and treated according to evidence-based national treatment guidelines using the National Comprehensive Cancer Network (NCCN) Practice Guidelines in Oncology. The findings were as follows: The most common histological types of cancer diagnosed at were adenocarcinoma, followed by mucinous adenocarcinoma, non-invasive carcinoma, adenocarcinoma in adenomatous polyp, adenocarcinoma in tubulovillous adenoma, and other specified types not previously mentioned. Colorectal Cancer Histology Adenoca in Adenomatous Polyp Adenoca in TV Adenoma 6% 4% Other Non-Invasive Carcinomas 6% 2% Mucinous Adenocarcinoma 8% Adenocarcinoma, NOS 74%

3 At, the age at the time of diagnosis ranged from 33 to 95 years, with the peak incidence being in the seventh and eighth decades of life. These findings are fairly consistent with figures supplied by the National Cancer Data Base (), as illustrated below. Percentage 35% 3 25% 2 15% 1 5% 1% 6% 1% Colorectal Cancer Age at Diagnosis vs 32% 26% 24% 23% 18% 2 16% 6% 4% 4% Age SMH The population diagnosed and treated at was predominantly Caucasian, followed by African American, and other. The chart below illustrates how data at compares with that of the. Colorectal Cancer Race SMH vs Percentage % 82% 1 4% 2% 4% White Black Hispanic Other Race SMH

4 Staging The charts below identify how the stage at the time of diagnosis at compares with national figures. The total number of stage III colon cancer cases and stage III and IV rectal cancer cases at are higher than national and state figures. These findings may be attributed to the slightly older population presenting to with advanced disease, as well as the significantly smaller number of cases being compared to much larger national and state figures. Colon Cancer Stage at Diagnosis vs 45% 4 35% 3 25% 2 15% 1 5% 43% 28% 25% 24% 2 18% 19% 19% 16% 13% 1 15% 9% 6% 6% 1% Stage 0 Stage I Stage II Stage III Stage IV N/A Unknown NJ Rectal Cancer Stage at Diagnosis vs 35% 3 25% 2 15% 1 5% 33% 33% 26% 2 21% % 14% 15% 13% 13% 1% Stage 0 Stage I Stage II Stage III Stage IV N/A Unknown NJ

5 Treatment Options The following charts show how colorectal cancer treatment at compares with national figures. While colon cancer treatment at is consistent with national figures, rectal cancer treatment differs. Again, this finding may be attributed to the slightly older population presenting to with advanced disease, as well as the significantly smaller number of cases being compared to much larger national and state figures. All colon and rectal cancer cases reviewed were found to receive all initial treatment in accordance with the National Comprehensive Cancer Network (NCCN) Guidelines. Colon Cancer First Course Treatment vs Surgery Only 59% 59% Surgery & Chemo Other Specified Therapy 26% 2 No 1st Course TX 8% 5% 1 15% 2 25% 3 35% 4 45% 5 55% 6 Percentage Rectal Cancer First Course Treatment vs Surgery Only 14% 28% Surgery & Chemo Radiation & Chemo 4% 29% Surgery, XRT, & Chemo 32% 43% Other Specified Therapy 14% No 1st Course TX 5% 1 15% 2 25% 3 35% 4 45% 5

6 The Cancer Committee at ensures that all patients diagnosed and/or treated with colorectal cancer are treated according to nationally accepted QI measures as measured by compliance with the current Commission on Cancer (CoC) Cancer Program Practice Profile Reports (CP3R) quality reporting tool. The colon and rectum performance rates for exceeds state, regional, and national figures for all three QI measures. The most current data available from the CoC CP3R quality reporting tool for year 2011 is listed below. Adjuvant chemotherapy is considered or administered within 4 months (120 days) of diagnosis for patients under the age of 80 with AJCC Stage III (lymph node positive) colon cancer. [ACT] ~ % My State (NJ) 90.1 % My Census Region (Atlantic) 90.3 % My ACS Division (Eastern) 87.5 % My CoC Program Type (CHCP) 92.7 % All CoC Approved Programs (ALL) 91.5 % At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer. [12RLN] ~ % My State (NJ) 88.5 % My Census Region (Atlantic) 89.2 % My ACS Division (Eastern) 89.6 % My CoC Program Type (CHCP) 84 % All CoC Approved Programs (ALL) 87.8 % Radiation therapy is considered or administered within 6 months (180 days) of diagnosis for patients under the age of 80 with clinical or pathologic AJCC T4N0M0 or Stage III receiving surgical resection for rectal cancer. [Rec/RT] ~ % My State (NJ) 92.3 % My ACS Division (Eastern) 92.4 % My Census Region (Atlantic) 91.4 % My CoC Program Type (CHCP) 92 % All CoC Approved Programs (ALL) 92.6 %

7 Conclusions All forty-seven cases reviewed met initial surgery and adjuvant treatment guidelines. Twenty-eight out of forty-seven cases reviewed did not meet the clinical workup portion of the guidelines due to not having a chest CT performed as part of the initial workup. Eighteen out of forty-seven cases reviewed did not meet the clinical workup portion of the guidelines due to not having a CEA performed as part of the initial workup. Five of the six Stage IV cases had incomplete genetic testing performed as part of the clinical workup portion of the guidelines. As a result of these findings, a letter will be sent to the surgeons and gastroenterologists practicing at in an effort to educate them of the importance of ordering a chest CT and CEA during the initial workup of a patient with known or suspected colorectal cancer. In addition, the Medical Executive Committee and the Chief of Surgery will also be notified of the review findings. Also, due to the importance of genetic testing, a recommendation will be made to the Cancer Committee to adopt Improving Genetic Testing for Stage IV Colorectal Patients as a Quality Improvement initiative for References 1. AJCC Cancer Staging Manual, 7 th edition, American Joint Committee on Cancer, National Cancer Data Base, American College of Surgeons Commission on Cancer. 3. National Comprehensive Cancer Network (NCCN) Practice Guidelines in Oncology for Colon Cancer, Version National Comprehensive Cancer Network (NCCN) Practice Guidelines in Oncology for Rectal Cancer, Version

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