Timing of adjuvant chemotherapy in stage III colon cancer as a measure of quality: Reasons for noncompliance.

Abstract

640 Background: The Institute of Medicine's report on improving cancer care, along with the evolution of ASCO's Quality Oncology Practice Initiative, has helped to develop process measures into critical quality of cancer care indicators. One such measure relates to "receipt of chemotherapy for stage III colon cancer (CC) within 120 days of diagnosis" and is now being incorporated into processes including hospital accreditation (American College of Surgeons; ACS), managed care contracts and Center for Medicare and Medicaid Services (CMS) quality monitoring. To better understand potential pitfalls related to the strict guidelines of this measure, we sought to evaluate institutional adherence at a tertiary care cancer center and to examine the reasons for non-compliance. Methods: A retrospective review was performed of all cases of stage III colon cancer reported at a single institution from 2008 – 2012. Coding for compliance was performed using standard ACS guidelines. Results: A total of 122 eligible cases were identified and consisted of 49 (40.2%) women and 73 (59.8%) men with a median age of 58 (range 32 - 77). Overall, 15 (12.3%) cases were non-compliant with 2 (1.6%) lost to follow up. Of the non-compliant cases, 14 (93.3%) cases did go on to receive chemotherapy while 1 (6.7%) never received adjuvant treatment. Of those receiving delayed treatment, 7 were due to patient-centered factors [e.g. patient timing preference (n=4), request for chemotherapy closer to home (n=2) and lost to follow up (n=1)]. Other reasons included delays at outside facilities (n=4), postoperative complications (n=1) and insurance approval (n=1). In 2 cases, designation of date of diagnosis based on suspicion rather than definitive biopsy contributed to non-compliant status. Conclusions: Our center averaged an annual compliance with the CC adjuvant therapy measure of approximately 90%. Larger scale studies are indicated to determine whether refinements in coding guides that account for patient preferences, clear diagnosis dates and cross-facility care could better reflect quality of care, and also promote improved patient-centered multidisciplinary management.