Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 147 No. 4748 (2017)

Quality indicators of colorectal cancer care in southern Switzerland: results from a population-based study

DOI
https://doi.org/10.4414/smw.2017.14530
Cite this as:
Swiss Med Wkly. 2017;147:w14530
Published
20.11.2017

Abstract

AIM OF THE STUDY

Assessing the quality of cancer care (QoCC) has become increasingly relevant to providers, regulators and purchasers of healthcare worldwide. The aim of this study was to assess adherence to validated quality indicators (QIs) for colorectal cancer (CRC) in a population-based setting, and to compare results with the available literature.

METHODS

All colorectal cancers diagnosed between 1 January 2011 and 31 December 2012 were identified from the files of the population-based Ticino Cancer Registry, southern Switzerland. We computed 12 core QIs, approved by use of the validated Delphi methodology and for which all the necessary medical documentation was available or only minor data collection was still needed to complete the analysis: three for diagnosis, two for pathology and seven for treatment (surgery, oncology and radiotherapy). Each QI was analysed as proportion (%) with 95% confidence interval, following the approach “available case analysis”.

RESULTS

A total of 474 colorectal cancers were identified: 86.9% patients were diagnosed after they reported symptoms, 90.2% had preoperative colonoscopy, 8.7% underwent emergency surgery, 97.2% had a surgical resection with tumour-free margins, and for 86.6% at least 12 lymph nodes were examined. The overall 30-day postoperative mortality was 3.6% and 66.7% of locally advanced rectal cancers benefited of neoadjuvant radiotherapy ± chemotherapy.

CONCLUSIONS

Our study showed the feasibility of assessing QoCC using Cancer Registry population-based data. Results according to the clinical domain of pathology, surgery, oncology and radio-oncology in southern Switzerland are generally positive and encouraging, sometimes more favourable in comparison with other international studies, except the very low proportion of patients with a diagnosis based on opportunistic screening (8.6%). Considering the lack in the literature of population-based studies, further national and international reports are urgently needed for comparative analysis as well as standardisation of QI definition is absolutely necessary for inter-regional comparative goals.

References

  1. Malin JL, Schneider EC, Epstein AM, Adams J, Emanuel EJ, Kahn KL. Results of the National Initiative for Cancer Care Quality: how can we improve the quality of cancer care in the United States? J Clin Oncol. 2006;24(4):626–34. doi:.https://doi.org/10.1200/JCO.2005.03.3365
  2. Schneider EC, Epstein AM, Malin JL, Kahn KL, Emanuel EJ. Developing a system to assess the quality of cancer care: ASCO’s national initiative on cancer care quality. J Clin Oncol. 2004;22(15):2985–91. doi:.https://doi.org/10.1200/JCO.2004.09.087
  3. Campbell SM, Roland MO, Buetow SA. Defining quality of care. Soc Sci Med. 2000;51(11):1611–25. doi:.https://doi.org/10.1016/S0277-9536(00)00057-5
  4. Ferlay J, Parkin DM, Steliarova-Foucher E. Estimates of cancer incidence and mortality in Europe in 2008. Eur J Cancer. 2010;46(4):765–81. doi:.https://doi.org/10.1016/j.ejca.2009.12.014
  5. Fitzmaurice C, Dicker D, Pain A, Hamavid H, Moradi-Lakeh M, MacIntyre MF, et al.; Global Burden of Disease Cancer Collaboration. The Global Burden of Cancer 2013. JAMA Oncol. 2015;1(4):505–27. doi:.https://doi.org/10.1001/jamaoncol.2015.0735
  6. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer. 2013;49(6):1374–403. doi:.https://doi.org/10.1016/j.ejca.2012.12.027
  7. National Institute for Cancer Epidemiology and Registration (NICER). http://www.nicer.org/. 2016.
  8. Bordoni A, Spitale A, Ortelli L, Mazzola P, Peverelli S. Registro cantonale dei tumori. http://www.ti.ch/cancer. 2017.
  9. Bouchardy C, Lutz JM, Kühni C, Pury P, Wyss N, Strippoli MP, et al. I tumori in Svizzera. Situazione e sviluppi dal 1983 al 2007. Ufficio Federale di Statistica (UFS): Neuchâtel; 2011.
  10. Arndt V, Feller A, Hauri D, Heusser R, Junker C, Kuehni C, et al. I tumori in Svizzera, Rapporto 2015. Situazione e sviluppi 1983-2012. Ufficio Federale di Statistica (UFS): Neuchâtel; 2016.
  11. Bianchi V, Spitale A, Ortelli L, Mazzucchelli L, Bordoni A ; QC3 CRC Working Group. Quality indicators of clinical cancer care (QC3) in colorectal cancer. BMJ Open. 2013;3(7): e002818. doi:.https://doi.org/10.1136/bmjopen-2013-002818
  12. Parkin DM, Chen VW, Ferlay J, Galceran J, Storm HH, Whelan SL. Comparability and quality control in cancer registration. IARC Technical Report No 19. IARC: Lyon; 2004.
  13. Tyczynski JE, Démaret E, Parkin DM. Standards and guidelines for cancer registration in Europe. The ENCR recommendations. Volume I. IARC Technical Publication n.40. IARC: Lyon; 2003.
  14. Ferlay J, Burkhard C, Whelan S, Parkin DM. Check and Conversion Programs for Cancer Registries (IARC/IACR Tools for Cancer Registries). IARC Technical Report No. 42. IARC: Lyon; 2005.
  15. Martos C, Crocetti E, Visser O, Rous B, Cancer Data Quality Checks Working Group. A proposal on cancer data quality check: one common procedure for European cancer registries. Publications Office of the European Union: Luxembourg; 2014.
  16. European Commission Joint Research Centre. JRC-ENCR Quality Check Software, Version 1.7.1. Available from: http://www.encr.eu/index.php/downloads/jrc-encr-qcs; 2016.
  17. Bullard J, Coleman MP, Robinson D, Lutz JM, Bell J, Peto J. Completeness of cancer registration: a new method for routine use. Br J Cancer. 2000;82(5):1111–6. doi:.https://doi.org/10.1054/bjoc.1999.1048
  18. Bosman FT, Carneiro F, Hruban RH, Theise ND. WHO classification of tumours of the digestive system. International Agency for Research on Cancer: Lyon; 2010.
  19. Fritz A, Percy C, Jack A, Shanmugaratnam K, Sobin L, Parkin DM, et al. International Classification of Diseases for Oncology. 3rd ed. World Health Organization: Geneva; 2000.
  20. Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti AE. AJCC Cancer Staging. Seventh Edition. Springer: New York; 2010.
  21. Park JS, Huh JW, Park YA, Cho YB, Yun SH, Kim HC, et al. A circumferential resection margin of 1 mm is a negative prognostic factor in rectal cancer patients with and without neoadjuvant chemoradiotherapy. Dis Colon Rectum. 2014;57(8):933–40. doi:.https://doi.org/10.1097/DCR.0000000000000171
  22. Mathoulin-Pélissier S, Bécouarn Y, Belleannée G, Pinon E, Jaffré A, Coureau G, et al.; Regional Aquitaine Group for Colorectal cancer GRACCOR. Quality indicators for colorectal cancer surgery and care according to patient-, tumor-, and hospital-related factors. BMC Cancer. 2012;12(1):297. doi:.https://doi.org/10.1186/1471-2407-12-297
  23. Khrizman P, Niland JC, ter Veer A, Milne D, Bullard Dunn K, Carson WE, 3rd, et al. Postoperative adjuvant chemotherapy use in patients with stage II/III rectal cancer treated with neoadjuvant therapy: a national comprehensive cancer network analysis. J Clin Oncol. 2013;31(1):30–8. doi:.https://doi.org/10.1200/JCO.2011.40.3188
  24. Klinkhammer-Schalke M, Gerken M, Barlag H, Tillack A. Was können Klinische Krebsregister in Zukunft für die bevölkerungsbezogene Umsetzung evidenzbasierter Leitlinien leisten? [Quality management in oncology supported by clinical cancer registries]. Z Evid Fortbild Qual Gesundhwes. 2015;109(6):452–8. doi:. Article in German.https://doi.org/10.1016/j.zefq.2015.08.001
  25. Sancho-Muriel J, Frasson M, Hervás D, Flor-Lorente B, Ramos Rodriguez JL, Romero Simó M, et al., ANACO Study Group. Resultados quirúrgicos estándar tras resección oncológica de colon. Creación de un nomograma para la autoevaluación [Standard outcome indicators after colon cancer resection. Creation of a nomogram for autoevaluation]. Cir Esp. 2017;95(1):30–7. doi:.https://doi.org/10.1016/j.ciresp.2016.10.001
  26. Siegel EM, Jacobsen PB, Malafa M, Fulp W, Fletcher M, Lee JH, et al. Evaluating the quality of colorectal cancer care in the state of Florida: results from the Florida Initiative for Quality Cancer Care. J Oncol Pract. 2012;8(4):239–45. doi:.https://doi.org/10.1200/JOP.2011.000477
  27. Vergara-Fernandez O, Swallow CJ, Victor JC, O’Connor BI, Gryphe R, MacRae HM, et al. Assessing outcomes following surgery for colorectal cancer using quality of care indicators. Can J Surg. 2010;53(4):232–40.
  28. Lorez M, Bordoni A, Bouchardy C, Bulliard JL, Camey B, Dehler S, et al. Evaluation of completeness of case ascertainment in Swiss cancer registration. Eur J Cancer Prev. 2017;26:S139–46. doi:.https://doi.org/10.1097/CEJ.0000000000000380
  29. Caldarella A, Amunni G, Angiolini C, Crocetti E, Di Costanzo F, Di Leo A, et al. Feasibility of evaluating quality cancer care using registry data and electronic health records: a population-based study. Int J Qual Health Care. 2012;24(4):411–8. doi:.https://doi.org/10.1093/intqhc/mzs020
  30. Isler JT, Brown PC, Lewis FG, Billingham RP. The role of preoperative colonoscopy in colorectal cancer. Dis Colon Rectum. 1987;30(6):435–9. doi:.https://doi.org/10.1007/BF02556492
  31. van Steenbergen LN, Lemmens VE, Straathof JW, Nijhuis PH, Gelderman WA, Coebergh JW. Improvable quality of diagnostic assessment of colorectal cancer in southern Netherlands. Eur J Gastroenterol Hepatol. 2009;21(5):570–5. doi:.https://doi.org/10.1097/MEG.0b013e328325a6ed
  32. Schmoll HJ, Van Cutsem E, Stein A, Valentini V, Glimelius B, Haustermans K, et al. ESMO Consensus Guidelines for management of patients with colon and rectal cancer. a personalized approach to clinical decision making. Ann Oncol. 2012;23(10):2479–516. doi:.https://doi.org/10.1093/annonc/mds236
  33. Hermanek P, Merkel S, Hohenberger W. Prognosis of rectal carcinoma after multimodal treatment: ypTNM classification and tumor regression grading are essential. Anticancer Res. 2013;33(2):559–66.
  34. Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, et al.; MRC CR07/NCIC-CTG CO16 Trial Investigators; NCRI Colorectal Cancer Study Group. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet. 2009;373(9666):821–8. doi:.https://doi.org/10.1016/S0140-6736(09)60485-2
  35. Sjo OH, Larsen S, Lunde OC, Nesbakken A. Short term outcome after emergency and elective surgery for colon cancer. Colorectal Dis. 2009;11(7):733–9. doi:.https://doi.org/10.1111/j.1463-1318.2008.01613.x
  36. Kelly M, Sharp L, Dwane F, Kelleher T, Comber H. Factors predicting hospital length-of-stay and readmission after colorectal resection: a population-based study of elective and emergency admissions. BMC Health Serv Res. 2012;12(1):77. doi:.https://doi.org/10.1186/1472-6963-12-77
  37. Gooiker GA, Dekker JW, Bastiaannet E, van der Geest LG, Merkus JW, van de Velde CJ, et al. Risk factors for excess mortality in the first year after curative surgery for colorectal cancer. Ann Surg Oncol. 2012;19(8):2428–34. doi:.https://doi.org/10.1245/s10434-012-2294-6
  38. Iversen LH. Aspects of survival from colorectal cancer in Denmark. Dan Med J. 2012;59(4):B4428.
  39. Al-Refaie WB, Parsons HM, Habermann EB, Kwaan M, Spencer MP, Henderson WG, et al. Operative outcomes beyond 30-day mortality: colorectal cancer surgery in oldest old. Ann Surg. 2011;253(5):947–52. doi:.https://doi.org/10.1097/SLA.0b013e318216f56e
  40. Morris EJ, Taylor EF, Thomas JD, Quirke P, Finan PJ, Coleman MP, et al. Thirty-day postoperative mortality after colorectal cancer surgery in England. Gut. 2011;60(6):806–13. doi:.https://doi.org/10.1136/gut.2010.232181
  41. Yang Z, Chen H, Liao Y, Xiang J, Kang L, Wang L, et al. Clinicopathological characteristics and long-term outcomes of colorectal cancer in elderly Chinese patients undergoing potentially curative surgery. Surg Today. 2014;44(1):115–22. doi:.https://doi.org/10.1007/s00595-013-0507-7
  42. Porter GA, Urquhart R, Bu J, Johnson P, Grunfeld E. The impact of audit and feedback on nodal harvest in colorectal cancer. BMC Cancer. 2011;11(1):2. doi:.https://doi.org/10.1186/1471-2407-11-2
  43. Damhuis RA, Wijnhoven BP, Plaisier PW, Kirkels WJ, Kranse R, van Lanschot JJ. Comparison of 30-day, 90-day and in-hospital postoperative mortality for eight different cancer types. Br J Surg. 2012;99(8):1149–54. doi:.https://doi.org/10.1002/bjs.8813
  44. Paulson EC, Mitra N, Sonnad S, Armstrong K, Wirtalla C, Kelz RR, et al. National Cancer Institute designation predicts improved outcomes in colorectal cancer surgery. Ann Surg. 2008;248(4):675–86.
  45. Ostenfeld EB, Erichsen R, Iversen LH, Gandrup P, Nørgaard M, Jacobsen J. Survival of patients with colon and rectal cancer in central and northern Denmark, 1998-2009. Clin Epidemiol. 2011;3(Suppl 1):27–34. doi:.https://doi.org/10.2147/CLEP.S20617
  46. van Gestel YR, Lemmens VE, de Hingh IH, Steevens J, Rutten HJ, Nieuwenhuijzen GA, et al. Influence of comorbidity and age on 1-, 2-, and 3-month postoperative mortality rates in gastrointestinal cancer patients. Ann Surg Oncol. 2013;20(2):371–80. doi:. Correction in: Ann Surg Oncol. 2013;20(Suppl 3):749. doi:https://doi.org/10.1245/s10434-012-2663-1
  47. Mik M, Dziki Ł, Trzciński R, Dziki A. Risk factors of 30-day mortality following surgery for colorectal cancer. Pol Przegl Chir. 2016;88(1):26–31.
  48. Labianca R, Nordlinger B, Beretta GD, Brouquet A, Cervantes A ; ESMO Guidelines Working Group. Primary colon cancer: ESMO Clinical Practice Guidelines for diagnosis, adjuvant treatment and follow-up. Ann Oncol. 2010;21(Suppl 5):v70–7. doi:.https://doi.org/10.1093/annonc/mdq168
  49. Gosens MJ, Klaassen RA, Tan-Go I, Rutten HJ, Martijn H, van den Brule AJ, et al. Circumferential margin involvement is the crucial prognostic factor after multimodality treatment in patients with locally advanced rectal carcinoma. Clin Cancer Res. 2007;13(22 Pt 1):6617–23. doi:.https://doi.org/10.1158/1078-0432.CCR-07-1197
  50. Morris EJ, Maughan NJ, Forman D, Quirke P. Identifying stage III colorectal cancer patients: the influence of the patient, surgeon, and pathologist. J Clin Oncol. 2007;25(18):2573–9. doi:.https://doi.org/10.1200/JCO.2007.11.0445
  51. Bilimoria KY, Bentrem DJ, Stewart AK, Talamonti MS, Winchester DP, Russell TR, et al. Lymph node evaluation as a colon cancer quality measure: a national hospital report card. J Natl Cancer Inst. 2008;100(18):1310–7. doi:.https://doi.org/10.1093/jnci/djn293
  52. Dejardin O, Ruault E, Jooste V, Pornet C, Bouvier V, Bouvier AM, et al. Volume of surgical activity and lymph node evaluation for patients with colorectal cancer in France. Dig Liver Dis. 2012;44(3):261–7. doi:.https://doi.org/10.1016/j.dld.2011.10.003
  53. Porter GA, Urquhart R, Bu J, Johnson P, Rayson D, Grunfeld E. Improving nodal harvest in colorectal cancer: so what? Ann Surg Oncol. 2012;19(4):1066–73. doi:.https://doi.org/10.1245/s10434-011-2073-9
  54. Valsecchi ME, Leighton J, Jr, Tester W. Modifiable factors that influence colon cancer lymph node sampling and examination. Clin Colorectal Cancer. 2010;9(3):162–7. doi:.https://doi.org/10.3816/CCC.2010.n.022
  55. Chou JF, Row D, Gonen M, Liu YH, Schrag D, Weiser MR. Clinical and pathologic factors that predict lymph node yield from surgical specimens in colorectal cancer: a population-based study. Cancer. 2010;116(11):2560–70. doi:.https://doi.org/10.1002/cncr.25032
  56. Chung KP, Chang YJ, Lai MS, Kuo RN, Cheng SH, Chen LT, et al. Is quality of colorectal cancer care good enough? Core measures development and its application for comparing hospitals in Taiwan. BMC Health Serv Res. 2010;10(1):27. doi:.https://doi.org/10.1186/1472-6963-10-27
  57. Glimelius B, Påhlman L, Cervantes A ; ESMO Guidelines Working Group. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(Suppl 5):v82–6. doi:.https://doi.org/10.1093/annonc/mdq170
  58. Spitale A, Franzetti-Pellanda A, Mazzola P, Richetti A, Mazzuchelli L, Bordoni A. Impact of preoperative radiotherapy on survival in locally advanced rectal cancer: an observational population-based study from the South of Switzerland. Eur J Cancer Prev. 2012;21(2):139–46. doi:.https://doi.org/10.1097/CEJ.0b013e32834c9c56
  59. Eldin NS, Yasui Y, Scarfe A, Winget M. Adherence to treatment guidelines in stage II/III rectal cancer in Alberta, Canada. Clin Oncol (R Coll Radiol). 2012;24(1):e9–17. doi:.https://doi.org/10.1016/j.clon.2011.07.005
  60. Fitzgerald TL, Biswas T, O’Brien K, Zervos EE, Wong JH. Neoadjuvant radiotherapy for rectal cancer: adherence to evidence-based guidelines in clinical practice. World J Surg. 2013;37(3):639–45. doi:.https://doi.org/10.1007/s00268-012-1862-z
  61. Saglam S, Bugra D, Saglam EK, Asoglu O, Balik E, Yamaner S, et al. Fourth versus eighth week surgery after neoadjuvant radiochemotherapy in T3-4/N0+ rectal cancer: Istanbul R-01 study. J Gastrointest Oncol. 2014;5(1):9–17.
  62. Tran CL, Udani S, Holt A, Arnell T, Kumar R, Stamos MJ. Evaluation of safety of increased time interval between chemoradiation and resection for rectal cancer. Am J Surg. 2006;192(6):873–7. doi:.https://doi.org/10.1016/j.amjsurg.2006.08.061
  63. Hewish M, Lord CJ, Martin SA, Cunningham D, Ashworth A. Mismatch repair deficient colorectal cancer in the era of personalized treatment. Nat Rev Clin Oncol. 2010;7(4):197–208. doi:.https://doi.org/10.1038/nrclinonc.2010.18
  64. Rayson D, Urquhart R, Cox M, Grunfeld E, Porter G. Adherence to clinical practice guidelines for adjuvant chemotherapy for colorectal cancer in a Canadian province: a population-based analysis. J Oncol Pract. 2012;8(4):253–9. doi:.https://doi.org/10.1200/JOP.2012.000578
  65. Abraham A, Habermann EB, Rothenberger DA, Kwaan M, Weinberg AD, Parsons HM, et al. Adjuvant chemotherapy for stage III colon cancer in the oldest old: results beyond clinical guidelines. Cancer. 2013;119(2):395–403. doi:.https://doi.org/10.1002/cncr.27755
  66. van den Broek CB, Bastiaannet E, Dekker JW, Portielje JE, de Craen AJ, Elferink MA, et al. Time trends in chemotherapy (administration and costs) and relative survival in stage III colon cancer patients - a large population-based study from 1990 to 2008. Acta Oncol. 2013;52(5):941–9. doi:.https://doi.org/10.3109/0284186X.2012.739730
  67. Phelip JM, Molinié F, Delafosse P, Launoy G, Trétarre B, Bara S, et al. A population-based study of adjuvant chemotherapy for stage-II and -III colon cancers. Gastroenterol Clin Biol. 2010;34(2):144–9. doi:.https://doi.org/10.1016/j.gcb.2009.08.012
  68. Johnson A, Rees JR, Schwenn M, Riddle B, Verrill C, Celaya MO, et al. Oncology care in rural northern new England. J Oncol Pract. 2010;6(2):81–9. doi:.https://doi.org/10.1200/JOP.200015

Most read articles by the same author(s)