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 #0225 15, 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
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 - 46.5% 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 #0223 36, 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
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% 60-26.5% 61, Low rectal abdominalperineal excision: 30.4% 62-31.9% 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
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
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