Outcomes in rectal cancer care in Uruguay: A study on quality indicators.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 234-234
Author(s):  
Santiago Fontes ◽  
Megan Berry ◽  
Ana Marín-Jiménez ◽  
Juan Carlos Sánchez ◽  
Graciela Reyes ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Treatment Outcomes ◽  
Quality Indicators ◽  
Rectal Carcinoma ◽  
Cancer Care ◽  
Diagnosis And Treatment ◽  
Internal Quality ◽  
Target Values

234 Background: For years, rectal cancer has been considered a model oncologic entity and significant therapeutic improvements have been made in the last two decades. However, evidence suggests there are important differences in quality of care between countries, institutions and teams. Therefore, population-based audits are of great importance to ensure quality cancer care. Quality indicators (QIs) provide information on safety and quality of cancer screening, diagnosis and treatment. Aim: To describe and analyze quality indicators for diagnosis and treatment of rectal carcinoma at a high-volume cancer center in Uruguay. Methods: A retrospective descriptive study was performed as a sub-analysis of a cohort of 971 patients. A total of 497 rectal or rectosigmoid-junction carcinoma patients treated between 2008 and 2020 at the Uruguayan National Cancer Institute were included. Previously validated target values formed the basis of the QIs used in this study. Each QI was reported as the proportion (% 95% CI) of patients fulfilling the criteria out of eligible patients. Kaplan–Meier method was used to calculate overall survival rates. Results: Mean age was 62 years, 59.5% were male, and 78% showed no evidence of disseminated disease at diagnosis. Diagnosis and staging: combined contrast-enhanced CT TAP scan was performed in 66% of the sample, 51% of cases had a total colonoscopy before elective curative intent surgery. Locoregional c-TN staging was assessed by high resolution MRI in 64% of cases. Only 30% and 63% of patients in the preoperatively irradiated and the nonirradiated groups had a minimum of 12 lymph nodes examined. Multimodal treatment: preoperative chemo-radiation was delivered for stages II and III middle/low-third rectal cancers in 81% of the cases. Adjuvant therapy was prescribed in 75% and 47% of stages III and II receiving surgery as upfront treatment, respectively. 78% of cStage IV patients received palliative chemotherapy. Surrogate indicators of outcome: 82% had distal tumor-free margins, although only 72% had a pathological circumferential radial margin ((y)pCRM) mentioned in the pathology report. Non-curative (R1,2) resections in M0 rectal carcinoma in our cohort was below the target value of <20%. 15% of our cases had a positive (y)pCRM. Treatment-outcomes: Our cumulative overall local recurrence was 12.6% and the 3-year overall survival rate was 84.8%. Conclusions: Continuous analysis of QIs in rectal cancer is necessary for internal quality management and for external quality assessment, to improve and compare treatment outcomes. Our results highlight the positive aspects of rectal cancer care at our center and reveal the weak points in diagnosis and treatment that need special attention. They will serve as a guide in the implementation of new strategies and programs that will aim to improve safety and quality of rectal cancer care for Uruguayan patients, regardless of where they live or are treated.

Results of a feasibility analysis of quality indicators for outpatient cancer care.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6623-6623
Author(s):  
Kerstin Hermes ◽  
Walter Baumann ◽  
Andreas Zimmermann ◽  
Stephan H. Schmitz
Keyword(s):  
Quality Of Care ◽  
Quality Indicators ◽  
Cancer Care ◽  
High Standard ◽  
Feasibility Analysis ◽  
Internal Quality ◽  
Quality Reporting ◽  
The Rich ◽  
Cancer Specialists

6623 Background: Quality indicators are increasingly used for measuring quality of care, for internal quality assurance, confidential benchmarking processes and anonymous quality reporting. The WINHO quality indicators project aims to develop and examine process quality measures for outpatient cancer care in Germany. This project is fully funded by the German Cancer Aid (Deutsche Krebshilfe). Currently, a set of 46 quality indicators exists. To gain better insights into what data can be retrieved from patient records and documentation systems in oncology practices, a feasibility analysis was conducted prior to data collection. Methods: 2176 questionnaires focusing on different aspects of the feasibility of quality indicators were sent to 295 doctors of WINHO partner practices. 1089 questionnaires were answered. Hence, for each of the 46 WINHO quality indicators 20 to 27 answers are available. Results: Although about 80% of the data required for the indicators are documented in patient charts, less than 30% of the data can be retrieved electronically. Particularly, data for indicators of the quality of pain management, holistic and palliative care often cannot be retrieved easily. By contrast, data on basal documentation, therapy planning and implementation are easier to obtain from patient charts. As a result, these indicators experience better evaluations by the office-based oncologists regarding frequency of occurrence, acceptance and reliability. However, high standard deviations show that documentation habits vary considerably within the group of office-based cancer specialists. Conclusions: Despite the large amount of data documented by oncologists in everyday practice, the information required to measure quality of care with indicators is complicated by low retrievability of data. Facilitating improved documentation and IT systems in oncology practices would ease the collection and examination of the rich information documented by office-based oncologists.

Improving the Quality of Rectal Cancer Care in the US: Is Accreditation Enough?

2018 ◽  
Vol 227 (4) ◽  
pp. S150
Author(s):  
Kerui Xu ◽  
Charles W. Acher ◽  
Nick A. Zaborek ◽  
Jessica R. Schumacher ◽  
Elise H. Lawson
Keyword(s):  
Rectal Cancer ◽  
Cancer Care ◽  
The Us

Measuring The Quality Of Cancer Care In The Barwon South Western Region, Victoria, Australia

2020 ◽  
Author(s):  
Leigh M Matheson ◽  
Graham Pitson ◽  
Cheng Hon Yap ◽  
Madhu Singh ◽  
Ian Collins ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Services ◽  
Quality Indicators ◽  
Cancer Care ◽  
Population Based ◽  
Western Region ◽  
Clinical Indicators ◽  
Clinical Quality ◽  
Quality Registry

ABSTRACT Objective The implementation of clinical quality indicators for monitoring cancer care in regional, rural and remote areas. Design Retrospective data from a population-based Clinical Quality Registry for lung, colorectal, and breast cancer. Setting All major Health Services in the Barwon South Western Region, Victoria, Australia. Participants All patients diagnosed with cancer presenting to a Health Service Intervention(s) Main Outcome Measures(s) Clinical Quality Indicators for Lung, Colorectal and Breast Cancer Results Clinical indicators included the following: discussion at multidisciplinary meetings, timeliness of care provided, type of care for different stages of the disease and survival outcomes. Many of the derived clinical indicator targets were reached. However, variation led to improvement in tumour stage being recorded in the medical record; improved awareness of the need for adjuvant chemotherapy for colorectal cancer; a reduction in time to treatment for lung cancer; reduced time to surgery for breast cancer; and highlighted the 30 day mortality post treatment for all of the tumour streams. Conclusions Clinical quality indicators allow for valuable insights into patterns of care, driving improvement in the quality of cancer care. These indicators are easily reproduced and may be of use to other cancer centres and health services.

Liver transplantation (Ltx) in patients with nonresectable liver metastases from colorectal carcinoma.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 577-577 ◽  
Author(s):  
Svein Dueland ◽  
Morten Hagness ◽  
Pal-Dag Line ◽  
Tim Scholz ◽  
P. Jorgensen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rectal Cancer ◽  
Overall Survival ◽  
Liver Metastases ◽  
Physical Function ◽  
Primary Tumor ◽  
Palliative Chemotherapy ◽  
Life Questionnaire ◽  
Line Chemotherapy

577 Background: Liver resection is considered the only curative treatment of liver metastases (mets) from colo-rectal (CRC) tumors. Ltx is standard of care in selected patients with hepatocellular carcinoma, cholangiocarcinoma and neuroendocrine tumors. Patients with non-resectable liver metastases (mets) from colo-rectal cancer (CRC) receiving palliative chemotherapy have a median survival of about 2 and 1 year from start of 1. and 2. line chemotherapy, respectively. Overall 5 years survival in CRC patients after start of palliative chemotherapy is about 5-10%. In this study we examined overall survival after Ltx in selected CRC patients. The primary endpoint of the study was overall survival at 2 years after Ltx Methods: Major inclusion criteria were: non-resectable liver mets, no extra hepatic disease or local relapse determined by PET/CT scan, CT- or MRI scan and colonoscopy. No mets. on frozen section biopsies at time of surgery, ECOG 0-1, at least one line of chemotherapy for metastatic disease. Postoperative immunosuppresion: mTOR inhibitor (Rapamune), mycofpenolmofetil and tapering doses of prednisolon. Quality of life questionnaire (EORTC-C30) pre Ltx, 3, 6 and 12 months post Ltx. Results: Thirteen men and 8 women with non-resectable liver only CRC liver mets received Ltx in the period of Nov 2006 to March 2011. Median age was 56 years (range 45-65 years). Thirteen patients had colon cancer and 8 patients had rectal cancer. The T-stage of the primary tumor was T2,T3 and T4 in 2, 16 and 3 patients, respectively. N status of the primary tumor was: pN0, pN1 and pN2 all 7 patients. Nine patients had received 1.line chemotherapy and 12 patients had received 2. or 3.line therapy. The median number of liver mets was 8 (range 2-40) and the median size of the largest lesion was 4.5cm (range 2.8-13cm). The patients had good, stabile or increased Global Health Score and Physical Function at all time points after Ltx. Fifteen patients with follow-up of 2 years or more or death within 2 years of Ltx had 2 years overall survival of 87%. Conclusions: Long term survival is obtained after Ltx in selected patients with non-resectable liver mets from CRC. The patients reported good quality of life and physical function after Ltx.

Using a disease pathway management approach to improve the quality of breast cancer care in Ontario.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 109-109
Author(s):  
Andrea Eisen ◽  
Jasmin Soobrian ◽  
Ashley Tyrrell ◽  
Clement Li ◽  
Derek Muradali ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Care ◽  
Performance Measurement ◽  
Quality Indicators ◽  
Cancer Care ◽  
Evidence Based ◽  
Breast Cancer Care ◽  
Patient Journey ◽  
The Impact

109 Background: Disease Pathway Management (DPM) is used by Cancer Care Ontario (CCO) to set priorities for cancer control, plan cancer services, and improve the quality of care in Ontario by promoting standardization. The DPM approach applies a framework to examine the performance of the entire system from prevention to end of life care, and to identify any gaps within the system. In 2014, DPM began its breast cancer pathway initiative by mapping the patient journey, depicting evidence-based best practice along the breast cancer care continuum, identifying where further guidance is needed for clinical decision making, and identifying gaps in quality of care and performance measurement indicators. Objective: To evaluate the impact of DPM on quality assessment of breast cancer care in Ontario. Methods: DPM convened a multidisciplinary breast cancer working group (WG) of 40 experts from across Ontario. The WG held 12 meetings and used guidelines developed by CCO’s Program in Evidence Based Care (or other sources as needed) to generate pathways for the prevention, screening and diagnosis, treatment, and follow-up care for breast cancer. The pathways were used as a framework to review the existing inventory of provincial breast cancer quality indicators, and to identify areas where evidence based guidance is needed. The pathways were subjected to an extensive review process before publication. Results: The expert WG identified 28 priority areas, including opportunities to develop guidance in areas where it is lacking (e.g. role of perioperative breast MRI; indications for contralateral prophylactic mastectomy) and system barriers that may hinder optimal care (e.g. biomarker assessment). The WG also used the pathways as a framework for evaluating performance measurement indicators by mapping 48 existing quality indicators for breast cancer to the pathway. Conclusions: The CCO DPM Breast Cancer pathways facilitated a province-wide, multidisciplinary process to promote quality standards, to identify gaps and overlaps in performance and quality measurement, and to recommend additional indicators more relevant to the quality of breast cancer care in Ontario.

Quality indicators of colorectal cancer care in a public healthcare institution in Uruguay: Results from a retrospective population-based study.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 234-234
Author(s):  
Santiago Fontes ◽  
Mauricio Cuello ◽  
Ana Marín-Jiménez ◽  
Juan Carlos Sánchez ◽  
Megan Berry ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Latin America ◽  
Adjuvant Chemotherapy ◽  
Quality Indicators ◽  
Cancer Care ◽  
Definitive Treatment ◽  
Colorectal Cancers ◽  
Public Healthcare ◽  
Target Values ◽  
Rectal Cancers

234 Background: There is an urgent need to assess quality of cancer care in Latin America, especially amongst the most prevalent tumors, such as colorectal cancer. The main aim of this study was to assess adherence to previously validated quality indicators (QIs) for colorectal cancer in the context of a public healthcare provider in Uruguay. Methods: Data regarding all colorectal cancers registered between January 1, 2008 and December 31, 2019 at the National Cancer Institute of Montevideo was collected through retrospective analysis of medical records. We used 12 QIs (4 diagnostic, 7 treatment,1 surveillance) validated in previous publications. Each QI was analyzed as a proportion (%) and compared to target values with 95% confidence interval. Results: A total of 808 colorectal cancers were identified; only 10.1% were diagnosed by screening, 87% were diagnosed after reporting symptoms and 29.5% underwent emergency surgery. A complete preoperative colonoscopy was performed in 47% of patients, 64% had a CT-TAP scan and 63% of locally advanced rectal cancers had staging MRI prior to definitive treatment. Surgical resection with tumor free margins was obtained in 97% of cases, and for 68% at least 12 lymph nodes were examined. Neoadjuvant radiotherapy plus chemotherapy as first therapeutic strategy was implemented in 79% of rectal cancers. High risk stage II and III colon cancer received adjuvant chemotherapy within 16 weeks of surgery in 72,9% of cases. Postoperative follow up with CEA was registered in 97% of our series. Most patients ≤ 75 years of age with metastatic unresectable colorectal cancer at diagnosis underwent first-line chemotherapy or bio-chemotherapy. A low level of adherence was identified in micro-satellite and RAS status testing, 16 and 22 patients respectively. Conclusions: This study is a pioneer study in Latin America. The standardization of QI definition to achieve interregional comparative goals remains an unmet need.Our data indicates there is much to improve in early diagnosis, preoperative staging, neoadjuvant therapy and molecular testing. QI indicators in surgery and adjuvant chemotherapy prescription are similar to those reported in international studies.

scholarly journals Implementation of a Hospital-Based Quality Assessment Program for Rectal Cancer

2014 ◽  
Vol 10 (3) ◽  
pp. e120-e129 ◽  
Author(s):  
Samantha Hendren ◽  
Ellen McKeown ◽  
Arden M. Morris ◽  
Sandra L. Wong ◽  
Mary Oerline ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Quality Improvement ◽  
Quality Assessment ◽  
Cancer Care ◽  
Registry Data ◽  
Tumor Registry ◽  
Assessment Program

A program linking tumor registry data to quality-improvement data for rectal cancer quality assessment was successfully implemented in 10 hospitals. This program can serve as a template for organizations interested in improving the quality of rectal cancer care.

Development of a comprehensive set of colorectal cancer care quality metrics.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 670-670
Author(s):  
Laurence E. McCahill ◽  
Jamie Kokko ◽  
Chris Werkemma ◽  
Pierson Ebrom ◽  
Sarat Khandavalli
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Rectal Cancer ◽  
Cancer Care ◽  
Quality Metrics ◽  
Care Quality ◽  
Post Treatment ◽  
Care Providers ◽  
Care Surgery

670 Background: Institute of Medicine report calls for improved quality of cancer care. Numerous entities have sought measures of health care quality, but there is limited consensus regarding metrics for quality of colorectal cancer (CRC) care. Current measures are very limited; there exist no comprehensive metrics for quality of CRC care across the continuum of care. We sought to identify robust quality metrics, including measures related to pathology, coordination of cancer care, surgery, radiation, chemotherapy and surveillance, in order to identify gaps in quality of CRC care. Methods: National guidelines (NCCN and ASCO), National Quality Forum, and select peer reviewed publications were reviewed to develop evidence based metrics to assess quality of CRC care from diagnosis to post treatment surveillance and survivorship. A core group of health care providers, including a surgical oncologist, a pathologist and a Cancer nurse practitioner developed the metrics based on literature review. Measures were reviewed by key physician stakeholders including Radiation Oncology, Medical Oncology, General surgery, and Gastroenterology to obtain support for the quality initiative at our institution. Results: Twenty-three quality metrics were developed including 6 metrics related to access and process, 6 related to pathology, 7 related to multidisciplinary care and 4 measures related to surveillance and survivorship. Novel metrics included documentation of a three generational cancer family history, documentation of preoperative CT imaging of chest/abdomen/pelvis, MSI and KRAS testing in specific populations, appropriate pre-operative radiation oncologist evaluation for rectal cancer, multidisciplinary team planning prior to treatment initiation for rectal cancer and patients with newly identified liver metastases, appropriate referral for genetic counseling and surveillance annual CT scans for 3 years post treatment. Conclusions: These novel and comprehensive metrics allow for detailed review of the quality of CRC care received by patients at our institution. Individual patient data are currently being abstracted to assess the utility and logistics of implementing these quality metrics at a community cancer center.

Guideline-Based Quality Indicators for Kidney and Bladder Cancer in Germany: Development and Implementation

2021 ◽  
pp. 1-8
Author(s):  
Johannes Rückher ◽  
Jessica Lobitz ◽  
Markus Follmann ◽  
Steffi Derenz ◽  
Stefanie Schmidt ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Quality Indicators ◽  
Cancer Society ◽  
Certification System ◽  
Results Of Treatment ◽  
Target Values ◽  
First Results ◽  
Ongoing Development ◽  
Guideline Program

<b><i>Introduction:</i></b> As part of the development of the evidence-based (S3) clinical practice guidelines for kidney and bladder cancer by the German Guideline Program in Oncology, quality indicators (QIs) were defined to measure the quality of care. Based on these guidelines and QIs, the German Cancer Society (DKG) developed two new certification systems. The aim of this article is to show the process of development and implementation of QIs in certified cancer centres. <b><i>Methods:</i></b> Based on strong recommendations of each guideline and an additional systematic literature review for national and international QIs, two sets of QIs were derived in a multistep standardized approach. These QIs were implemented in the centres in certification data sheets to measure their outcomes. First results of treatment years 2018 and 2019 are available. <b><i>Results:</i></b> The final sets include 9 QIs for kidney cancer and 12 QIs for bladder cancer. Two-thirds of the QIs were transferred to the data sheets. In 2018 and 2019, the results of all but one QI are within the plausibility limits. From 2020 on, they are replaced by stricter target values that will challenge centres to improve their outcomes. <b><i>Conclusions:</i></b> Guideline-derived QIs make relevant aspects of patient care measurable and consequently improvable. The first QI results are encouraging. However, the DKG certification system and the methods of measuring quality are under ongoing development. Systematic QI implementation and evaluation may help to generate broader databases and thus expand knowledge.

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