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Quality Indicators and Outcomes in a Prospective Cohort of Colorectal Cancer Patients

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Abstract

Background

Some quality indicators of proper health care in patients with colorectal cancer have been established.

Aims

Our goal was to evaluate the relationship between performing of certain procedures or treatments, included as quality indicators, and some outcomes of indicators in the follow-up of colorectal cancer patients.

Methods

This was a prospective cohort study of patients diagnosed with colorectal cancer that underwent surgery and were followed at 1, 2, 3, and 5 years. CT scanning, colonoscopy, chemotherapy, and radiotherapy were evaluated in relation to various clinical outcomes and PROM changes over 5 years. Multivariable generalized linear mixed models were used to evaluate their effect on mortality, complications, recurrence, and PROM changes (HAD, EQ-5D, EORTC-Q30) at the next follow-up.

Results

CT scanning or colonoscopy was related to a decrease in the risk of dying, while chemotherapy at a specified moment was related to an increased risk. In the case of recurrence, CT scanning and chemotherapy showed statistically increased the risk, while all the procedures and treatments influenced complications. Regarding PROM scales, CT scanning, colonoscopy, and radiotherapy showed statistically significant results with respect to an increase in anxiety and decrease in quality of life measured by the EORTC. However, undergoing radiotherapy at a specified moment increased depression levels, and overall, receiving radiotherapy decreased the quality of life of the patients, as measured by the EuroQol-5d.

Conclusions

After adjustment for sociodemographic factors, comorbidities, and severity of the disease, performing certain quality indicators of proper health care in patients with colorectal cancer was related to less mortality but higher adverse outcomes.

Trial Registration

ClinicalTrials.gov Identifier: NCT02488161.

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Availability of Data and Material

Data available upon request.

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Acknowledgements

We are grateful for the support of the 22 participating hospitals, to the patients who participated in the study, and to Nature Research Editing Service for the English language editing.

Funding

This work was supported in part by grants from the Instituto de Salud Carlos III and the European Regional Development Fund (PS09/00314, PS09/00910, PS09/00746, PS09/00805, PI09/90460, PI09/90490, PI09/90453, PI09/90441, PI09/90397); the Departments of Health (2010111098) and Education, Language Policy and Culture (IT620-13) of the Basque Government; the Research Committee of Hospital Galdakao; and the thematic network–REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas)–of the Instituto de Salud Carlos III.

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Authors and Affiliations

  1. Unidad de Investigación, Hospital Galdakao-Usansolo, Barrio Labeaga s/n, 48960, Galdakao, Bizkaia, Spain

    José M. Quintana, Ane Anton-Ladislao, Nerea Gonzalez, Susana Garcia-Gutierrez & Urko Aguirre

  2. Servicio de Cirugía General, Hospital Basurto, Bilbao, Bizkaia, Spain

    Santiago Lázaro

  3. Unidad de Epidemiología Clínica, Corporacio Parc Tauli, Barcelona, Spain

    Marisa Bare

  4. Centro Nacional de Epidemiología, ISCIII, Madrid, Spain

    Nerea Fernandez de Larrea

  5. Unidad de Investigación, Hospital Costa del Sol, Malaga, Spain

    Maximino Redondo

  6. Unidad de Investigación, Hospital Basurto, Bilbao, Bizkaia, Spain

    Antonio Escobar

  7. Unidad de Investigación, Hospital Donostia/BioDonostia, Donostia, Guipuzkoa, Spain

    Cristina Sarasqueta

  8. UDG Salud Publica, Distrito AP Sevilla, Sevilla, Spain

    Eduardo Briones

  9. Red de Investigación en Servicios Sanitarios Y Enfermedades Crónicas (REDISSEC), Galdakao, Spain

    José M. Quintana, Ane Anton-Ladislao, Santiago Lázaro, Nerea Gonzalez, Marisa Bare, Maximino Redondo, Antonio Escobar, Cristina Sarasqueta, Susana Garcia-Gutierrez & Urko Aguirre

  10. CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain

    Nerea Fernandez de Larrea & Eduardo Briones

Authors
  1. José M. Quintana
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  2. Ane Anton-Ladislao
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  3. Santiago Lázaro
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  4. Nerea Gonzalez
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  5. Marisa Bare
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  6. Nerea Fernandez de Larrea
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  7. Maximino Redondo
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  8. Antonio Escobar
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  9. Cristina Sarasqueta
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  10. Susana Garcia-Gutierrez
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  11. Urko Aguirre
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  12. Eduardo Briones
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  13. for the REDISSEC-CARESS/C. C. R. group
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Contributions

All the authors contributed to the study conception and design. Material preparation was performed by José M. Quintana, Ane Anton-Ladislao, and Urko Aguirre; data collection was performed by all the authors; and analysis was performed by José M. Quintana and Ane Anton-Ladislao. The first draft of the manuscript was written by José M. Quintana, Ane Anton-Ladislao, and Susana Garcia-Gutierrez; all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to José M. Quintana.

Ethics declarations

Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Basque Country Ethics Committee (Approval Number: 11/23/2010).

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Consent for Publication

Patients signed informed consent regarding publishing their data keeping anonymous all personal information.

Competing Interests

The authors declare no competing interests.

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Quintana, J.M., Anton-Ladislao, A., Lázaro, S. et al. Quality Indicators and Outcomes in a Prospective Cohort of Colorectal Cancer Patients. J Gastrointest Canc 54, 20–26 (2023). https://doi.org/10.1007/s12029-021-00779-8

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  • DOI: https://doi.org/10.1007/s12029-021-00779-8

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