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Association of Adherence to Quality Metrics with Recurrence or Mortality among Veterans with Colorectal Cancer

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

The National Comprehensive Cancer Network has defined metrics for colorectal cancer; however, the association of metric adherence with patient clinical outcomes remains underexplored. The study aim was to evaluate the association of National Comprehensive Cancer Network metric adherence with recurrence and mortality in Veterans with nonmetastatic colorectal cancer.

Methods

Veterans with stage I–III colorectal cancer who underwent non-emergent resection from 2001 to 2015 at a single Veterans Affairs Medical Center were included. The primary predictor was completion of eligible National Comprehensive Cancer Network metrics. The primary outcome was a composite of recurrence or all-cause death in three phases of care: surgical (up to 6 months after resection), treatment (6–18 months after resection), and surveillance (18 months–3 years after resection). Hazard ratios were estimated via Cox proportional hazards regression in a propensity score–weighted cohort.

Results

A total of 1107 electronic medical records of patients undergoing colorectal surgery were reviewed, and 379 patients were included (301 colon and 78 rectal cancer). In the surgical phase, the weighted analysis yielded a hazard ratio of 0.37 (95% confidence interval 0.12–1.13) for metric-adherent patients compared with non-adherent patients. In the treatment and surveillance phases, the hazard ratios for metric-adherent care were 0.68 (95% confidence interval 0.25–1.85) and 0.91 (95% confidence interval 0.31–2.68), respectively.

Conclusions

The National Comprehensive Cancer Network guideline metric adherence was associated with a lower rate of recurrence and death in the surgical phase of care among stage I–III patients with resected colorectal cancer.

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Acknowledgments

The authors would like to thank Jennifer Wharton, BS, for her contributions to IRB preparation. This work was supported by the Office of Academic Affiliations, Department of Veterans Affairs, VA National Quality Scholars Program, and with the use of facilities at VA Tennessee Valley Healthcare System, Nashville, TN.

Funding

Dr. Edwards is supported by the Office of Academic Affiliations, Department of Veterans Affairs (VA) National Quality Scholars Program.

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Authors and Affiliations

  1. Department of General Surgery, Vanderbilt University Medical Center & Tennessee Valley Healthcare System – Veterans Health Administration, Medical Center North, Suite CCC-4312, 1161 21st Avenue South, Nashville, TN, 37232-2730, USA

    Gretchen C. Edwards MD, MPH & Colleen M. Kiernan MD, MPH

  2. Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System - Veterans Health Administration, Nashville, TN, USA

    Gretchen C. Edwards MD, MPH, Lauren R. Samuels PhD, Robert S. Dittus MD, MPH & Christianne L. Roumie MD, MPH

  3. Department of Medicine, Division of Medical Oncology, Vanderbilt University Medical Center & Tennessee Valley Healthcare System – Veterans Health Administration, Nashville, TN, USA

    Richard L. Martin MD, MPH & Kenneth Wyman MD

  4. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    Lauren R. Samuels PhD

  5. Department of General Surgery, Division of Surgical Oncology, Vanderbilt University Medical Center, Nashville, TN, USA

    Christina E. Bailey MD, MSCI & Colleen M. Kiernan MD, MPH

  6. Departments of Surgery and Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA

    Rebecca A. Snyder MD, MPH

  7. Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA

    Robert S. Dittus MD, MPH & Christianne L. Roumie MD, MPH

Authors
  1. Gretchen C. Edwards MD, MPH
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  2. Richard L. Martin MD, MPH
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  3. Lauren R. Samuels PhD
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  4. Kenneth Wyman MD
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  5. Christina E. Bailey MD, MSCI
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  6. Colleen M. Kiernan MD, MPH
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  7. Rebecca A. Snyder MD, MPH
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  8. Robert S. Dittus MD, MPH
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  9. Christianne L. Roumie MD, MPH
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Contributions

Study conception and design: Edwards, Martin, Wyman, Snyder, Bailey, Roumie

Acquisition of data: Edwards, Martin, Snyder

Analysis and interpretation of data: Edwards, Samuels, Roumie

Drafting of the manuscript: Edwards, Samuels, Roumie

Critical revision of the manuscript: Edwards, Martin, Samuels, Wyman, Bailey, Kiernan, Snyder, Dittus, Roumie

Corresponding author

Correspondence to Gretchen C. Edwards MD, MPH.

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Edwards, G.C., Martin, R.L., Samuels, L.R. et al. Association of Adherence to Quality Metrics with Recurrence or Mortality among Veterans with Colorectal Cancer. J Gastrointest Surg 25, 2055–2064 (2021). https://doi.org/10.1007/s11605-020-04804-2

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