Quality of adjuvant chemotherapy in stage III colon cancer.

Abstract

228 Background: The goal of the Systemic Treatment Program at Cancer Care Ontario is to ensure equitable access to high quality systemic therapy for all patients in Ontario. To provide information on performance and inform planning we evaluated the quality of care in stage III colon cancer pertaining to adjuvant chemotherapy using multiple indicators focusing on access, guideline concordance and toxicity. Methods: Patients with stage III colon cancer in 2010 were identified from the Ontario Cancer Registry then linked with several other health administrative databases to obtain information regarding wait times, consultation with medical oncology, receipt of guideline concordant adjuvant chemotherapy and treatment related toxicity. Results: In 2010, 1,133 patients were diagnosed with stage III colon cancer in Ontario of whom 49% were women and 60% were older than 65. 92% of patients were seen by a medical oncologist within four months of diagnosis. Among patients seen at one of the regional cancer centres, 56% consulted with an oncologist within the provincial target of 14 days from referral. Overall, 47% of patients received oxaliplatin-based adjuvant chemotherapy therapy; 70% of those younger than 65 versus 34% of those older than 65. Among patients older than 65 on whom information regarding oral chemotherapy use is available in Ontario, 58% received adjuvant chemotherapy (59% oxaliplatin-based, 41% capecitabine). With respect to timeliness of adjuvant chemotherapy, 85% of patients received chemotherapy within 120 days from diagnosis, 57% started treatment within 60 days of surgery and 61% started within 28 days of consultation with a medical oncologist. Among patients who received oxaliplatin based adjuvant chemotherapy, 42% had at least one ER visit and 18% at least one hospital admission during adjuvant treatment. There was evidence of geographic and age-based variation across multiple indicators. Conclusions: While good quality was observed for several of the indicators examined, opportunities for improvement were identified in access to treatment and toxicity management. Evaluating multiple indicators in the same population provides a broader perspective on quality facilitating a focused, efficient approach to improvement efforts.