TY - JOUR
T1 - Assessing compliance with national comprehensive cancer network guidelines for elderly patients with stage III colon cancer
T2 - The fox chase cancer center partners' initiative
AU - O'Grady, Margaret A.
AU - Slater, Elyse
AU - Sigurdson, Elin R.
AU - Meropol, Neal J.
AU - Weinstein, Alan
AU - Lusch, Charles J.
AU - Sein, Elaine
AU - Keeley, Patricia
AU - Miller, Bonnie
AU - Engstrom, Paul F.
AU - Cohen, Steven J.
N1 - Copyright © 2011 Elsevier Inc. All rights reserved.
PY - 2011/6
Y1 - 2011/6
N2 - Background: Fox Chase Cancer Center Partners (FCCCP) performs an annual quality review of affiliate practices based on National Comprehensive Cancer Network (NCCN) guidelines. Given recent treatment advances, we initiated this medical record review in elderly patients with stage III colon cancer to measure compliance with these guidelines. Methods: Medical records of 124 patients age ≥ 65 diagnosed with stage III colon cancer between 2003 and 2006 were reviewed. Metrics were developed and based on NCCN guidelines for workup and staging, treatment. and gerontology. Documentation was reviewed via paper (13 sites) and electronic record (2 sites). Results: High compliance with staging and workup guidelines was noted with chest imaging (100%), stage (98%), computed tomography (CT) of the abdomen/pelvis (93%), pathology (91%), and carcinoembryonic antigen (CEA; 91%). Activities of daily living were documented commonly (83%) but colonoscopy less (75%). Age and life expectancy were discussed with the patient in only 49%. Nearly all patients (123 of 124 patients) received adjuvant chemotherapy, with 76 patients (61%) receiving oxaliplatin. Common regimens were FOLFOX (oxaliplatin plus infusional/bolus 5-fluorouracil and folinic acid) 54%, 5-fluorouracil/leucovorin (5-FU/LV; 19%), and capecitabine (12%). Reasons for excluding oxaliplatin were comorbidity (68%), age (19%), and not specified (13%). Three-quarters of the patients had ≥ 12 lymph nodes sampled and 56% identified the radial margin. Nearly all patients (115 = 93%) received surveillance with history and physical and CEA. Surveillance CT was performed in 78% of the patients. Conclusions: A quality review of community oncology practices can assess implementation of treatment advances. Guideline compliance for elderly patients with stage III colon cancer is generally high. Forty percent did not receive oxaliplatin and documentation of life expectancy was infrequent. Further study of oncologist decision making for elderly colon cancer patients is warranted.
AB - Background: Fox Chase Cancer Center Partners (FCCCP) performs an annual quality review of affiliate practices based on National Comprehensive Cancer Network (NCCN) guidelines. Given recent treatment advances, we initiated this medical record review in elderly patients with stage III colon cancer to measure compliance with these guidelines. Methods: Medical records of 124 patients age ≥ 65 diagnosed with stage III colon cancer between 2003 and 2006 were reviewed. Metrics were developed and based on NCCN guidelines for workup and staging, treatment. and gerontology. Documentation was reviewed via paper (13 sites) and electronic record (2 sites). Results: High compliance with staging and workup guidelines was noted with chest imaging (100%), stage (98%), computed tomography (CT) of the abdomen/pelvis (93%), pathology (91%), and carcinoembryonic antigen (CEA; 91%). Activities of daily living were documented commonly (83%) but colonoscopy less (75%). Age and life expectancy were discussed with the patient in only 49%. Nearly all patients (123 of 124 patients) received adjuvant chemotherapy, with 76 patients (61%) receiving oxaliplatin. Common regimens were FOLFOX (oxaliplatin plus infusional/bolus 5-fluorouracil and folinic acid) 54%, 5-fluorouracil/leucovorin (5-FU/LV; 19%), and capecitabine (12%). Reasons for excluding oxaliplatin were comorbidity (68%), age (19%), and not specified (13%). Three-quarters of the patients had ≥ 12 lymph nodes sampled and 56% identified the radial margin. Nearly all patients (115 = 93%) received surveillance with history and physical and CEA. Surveillance CT was performed in 78% of the patients. Conclusions: A quality review of community oncology practices can assess implementation of treatment advances. Guideline compliance for elderly patients with stage III colon cancer is generally high. Forty percent did not receive oxaliplatin and documentation of life expectancy was infrequent. Further study of oncologist decision making for elderly colon cancer patients is warranted.
KW - Aged
KW - Antineoplastic Agents/therapeutic use
KW - Chemotherapy, Adjuvant/statistics & numerical data
KW - Colonic Neoplasms/diagnosis
KW - Digestive System Surgical Procedures
KW - Female
KW - Guideline Adherence/statistics & numerical data
KW - Humans
KW - Male
KW - Medical Oncology/standards
KW - Neoplasm Staging
UR - http://www.scopus.com/inward/record.url?scp=79959372001&partnerID=8YFLogxK
U2 - 10.1016/j.clcc.2011.03.007
DO - 10.1016/j.clcc.2011.03.007
M3 - Article
C2 - 21859563
AN - SCOPUS:79959372001
SN - 1533-0028
VL - 10
SP - 113
EP - 116
JO - Clinical Colorectal Cancer
JF - Clinical Colorectal Cancer
IS - 2
ER -
