Abstract
Background
Many quality measures in cancer care are process measures. The rates of compliance for these measures over time have not been well described, and the relationships between measure compliance and survival are not well understood.
Methods
The National Cancer Database, representing cancer registry data from approximately 1500 Commission on Cancer (CoC) cancer programs, was queried to determine the rates of compliance, with the CoC’s colon cancer quality measure requiring 12 regional lymph nodes be removed at resection. Data were assessed in 2003, before the measure was reported to programs, through 2015. Measure compliance and risk-adjusted survival were examined by hospital type.
Results
From 2003 to 2015, 544,018 cases of colon cancer were analyzed for number of nodes removed. In 2003, compliance was 52.8% and National Cancer Institute (NCI) centers had the highest compliance rate (69.0%), followed by academic cancer centers (61.9%), comprehensive community hospitals (50.9%), and community hospitals (44.0%). Between 2003 and 2015, compliance improved for all hospital types, although differences remained. Risk-adjusted survival in 2009 was better at NCI centers [hazard ratio (HR) 0.76] than at academic cancer centers (HR 0.90), which had better survivals than comprehensive community programs (HR 0.93) when compared with patients treated at community hospitals.
Conclusion
After introduction of this quality measure, performance at CoC-accredited hospitals improved over the subsequent 13 years, and survival by hospital type paralleled measure compliance by hospital type. This demonstrated measurement may be associated with improvements in performance, and that there are differences in performance and outcome by hospital type.
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References
American College on Surgeons. Commission on cancer quality programs. https://www.facs.org/quality-programs/cancer. Accessed 16 Jan 2018.
Jacobson JO, Neuss MN, McNiff KK, Kadlubek P, Thacker LR 2nd, Song F, Eisenberg PD, Simone JV. Improvement in oncology practice performance through voluntary participation in the Quality Oncology Practice Initiative. J Clin Oncol. 2008;26(11):1893–98.
Berger AC, Sigurdson ER, LeVoyer T, Hanlon A, Mayer RJ, Macdonald JS, et al. Colon cancer survival is associated with decreasing ratio of metastatic to examined lymph nodes. J Clin Oncol. 2005;23(34):8706–12.
Chen SL, Bilchik AJ. More extensive nodal dissection improves survival for stages I to III of colon cancer: a population-based study. Ann Surg. 2006;244(4):602–10.
Goldstein NS. Lymph node recoveries from 2427 pT3 colorectal resection specimens spanning 45 years: recommendations for a minimum number of recovered lymph nodes based on predictive probabilities. Am J Surg Pathol. 2002;26(2):179–89.
Johnson PM, Porter GA, Ricciardi R, Baxter NN. Increasing negative lymph node count is independently associated with improved long-term survival in stage IIIB and IIIC colon cancer. J Clin Oncol. 2006;24(22):3570–5.
Le Voyer TE, Sigurdson ER, Hanlon AL, Mayer RJ, Macdonald JS, Catalano PJ, et al. Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J Clin Oncol. 2003;21(15):2912–9.
Chang GJ, Rodriguez-Bigas MA, Skibber JM, Moyer VA. Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst. 2007;99(6):433–41.
Fleming ID, Cooper JS, Henson DE, et al. (eds). AJCC cancer staging manual. 6th ed. Philadelphia: Lippincott Raven; 2001. p. 113–23.
Parsons HM, Begun JW, Kuntz KM, Tuttle TM, McGovern PM, Virnig BA. Lymph node evaluation for colon cancer in an era of quality guidelines: who improves? J Oncol Pract. 2013;9(4):e164–71.
Swanson RS, Compton CC, Stewart AK, Bland KI. The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol. 2003;10(1):65–71.
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):1310–17.
Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613–19.
US Department of Agriculture. Economic research service: 2013 rural–urban continuum codes. Washington: Economic Research Service US Department of Agriculture; 2013.
Shulman LN, Palis BE, McCabe R, Mallin K, Loomis A, Winchester D, et al. Survival as a quality metric of cancer care: Use of the National Cancer Data Base to assess hospital performance. J Oncol Pract. 2018;14(1):e59–72.
Pfister DG, Rubin DM, Elkin EB, Neill US, Duck E, Radzyner M, et al. Risk adjusting survival outcomes in hospitals that treat patients with cancer without information on cancer stage. JAMA Oncol. 2015;1(9):1303–10.
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Shulman, L.N., Browner, A.E., Palis, B.E. et al. Compliance with Cancer Quality Measures Over Time and Their Association with Survival Outcomes: The Commission on Cancer’s Experience with the Quality Measure Requiring at Least 12 Regional Lymph Nodes to be Removed and Analyzed with Colon Cancer Resections. Ann Surg Oncol 26, 1613–1621 (2019). https://doi.org/10.1245/s10434-019-07323-w
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DOI: https://doi.org/10.1245/s10434-019-07323-w