Measurement that matters: A systematic review and modified Delphi of multidisciplinary colorectal cancer quality indicators

Donnelly, Candice; Or, Michelle; Toh, James Wei Tatt; Thevaraja, Mathushan; Janssen, Anna; Shaw, Tim; Pathma‐Nathan, Nimalan; Harnett, Paul; Chiew, Kim-Lin; Vinod, Shalini; Sundaresan, Puma

doi:10.1111/ajco.13917

Cited by 3 publications

(4 citation statements)

References 131 publications

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“…The American Society of Colon and Rectal Surgeons and the European Society of Medical Oncology recommend that watch-and-wait approaches be reserved for investigational protocols . Aligning professional society recommendations with the NCCN will likely occur over time, but currently there are no quality indicators to guide the implementation and quality of watch-and-wait–based programs outside of the investigational setting . Several important clinical and logistical questions from a care delivery perspective remain unanswered around the widespread implementation of organ preservation, particularly watch and wait.…”

Section: Discussioncontrasting

confidence: 56%

“…10,11 Aligning professional society recommendations with the NCCN will likely occur over time, but currently there are no quality indicators to guide the implementation and quality of watch-and-waitbased programs outside of the investigational setting. [10][11][12] Several important clinical and logistical questions from a care delivery perspective remain unanswered around the widespread implementation of organ preservation, particularly watch and wait. Identifying candidates willing and able to perform long-term intensive surveillance outside of clinical trial settings and the intensity (frequency of reassessment and what modalities should be embedded) of surveillance programs are salient questions.…”

Section: Discussionmentioning

confidence: 99%

“…How to deliver watch and wait outside of clinical trials, and the processes for tracking the quality of care, are unknown. For example, a recent systematic review of multidisciplinary colorectal cancer quality indicators found that 6% of quality indicators addressed neoadjuvant therapy, 31.2% related to surgery, and none applied to patients who underwent a watch-and-wait therapy …”

Section: Introductionmentioning

confidence: 99%

“…For example, a recent systematic review of multidisciplinary colorectal cancer quality indicators found that 6% of quality indicators addressed neoadjuvant therapy, 31.2% related to surgery, and none applied to patients who underwent a watchand-wait therapy. 12 Total neoadjuvant therapy, sphincter-preserving surgery, and minimally invasive surgical approaches are increasing in the US, but paradigm shifts in rectal cancer care are occurring in organ preservation. [13][14][15] Because there are limited national data on organ preservation, we queried the National Cancer Database (NCDB) to assess trends in rectal cancer management from 2006 through 2020, hypothesizing that there would be an increasing adoption of organ preservation and pathologic complete responses.…”

mentioning

confidence: 99%

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Practice Patterns for Organ Preservation in US Patients With Rectal Cancer, 2006-2020

Loria,

Tejani,

Temple

et al. 2024

JAMA Oncol

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ImportanceIn March 2023, the National Comprehensive Cancer Network endorsed watch and wait for those with complete clinical response to total neoadjuvant therapy. Neoadjuvant therapy is highly efficacious, so this recommendation may have broad implications, but the current trends in organ preservation in the US are unknown.ObjectiveTo describe organ preservation trends among patients with rectal cancer in the US from 2006 to 2020.Design, Setting, and ParticipantsThis retrospective, observational case series included adults (aged ≥18 years) with rectal adenocarcinoma managed with curative intent from 2006 to 2020 in the National Cancer Database.ExposureThe year of treatment was the primary exposure. The type of therapy was chemotherapy, radiation, or surgery (proctectomy, transanal local excision, no tumor resection). The timing of therapy was classified as neoadjuvant or adjuvant.Main Outcomes and MeasuresThe primary outcome was the absolute annual proportion of organ preservation after radical treatment, defined as chemotherapy and/or radiation without tumor resection, proctectomy, or transanal local excision. A secondary analysis examined complete pathologic responses among eligible patients.ResultsOf the 175 545 patients included, the mean (SD) age was 63 (13) years, 39.7% were female, 17.4% had clinical stage I disease, 24.7% had stage IIA to IIC disease, 32.1% had stage IIIA to IIIC disease, and 25.7% had unknown stage. The absolute annual proportion of organ preservation increased by 9.8 percentage points (from 18.4% in 2006 to 28.2% in 2020; P &lt; .001). From 2006 to 2020, the absolute rate of organ preservation increased by 13.0 percentage points for patients with stage IIA to IIC disease (19.5% to 32.5%), 12.9 percentage points for patients with stage IIIA to IIC disease (16.2% to 29.1%), and 10.1 percentage points for unknown stages (16.5% to 26.6%; all P &lt; .001). Conversely, patients with stage I disease experienced a 6.1–percentage point absolute decline in organ preservation (from 26.4% in 2006 to 20.3% in 2020; P &lt; .001). The annual rate of transanal local excisions decreased for all stages. In the subgroup of 80 607 eligible patients, the proportion of complete pathologic responses increased from 6.5% in 2006 to 18.8% in 2020 (P &lt; .001).Conclusions and RelevanceThis case series shows that rectal cancer is increasingly being managed medically, especially among patients whose treatment historically relied on proctectomy. Given the National Comprehensive Cancer Network endorsement of watch and wait, the increasing trends in organ preservation, and the nearly 3-fold increase in complete pathologic responses, international professional societies should urgently develop multidisciplinary core outcome sets and care quality indicators to ensure high-quality rectal cancer research and care delivery accounting for organ preservation.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Practice Patterns for Organ Preservation in US Patients With Rectal Cancer, 2006-2020

Loria,

Tejani,

Temple

et al. 2024

JAMA Oncol

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Identifying a common data dictionary across colorectal cancer outcome registries: A mapping exercise to identify opportunities for data dictionary harmonisation

Mohan,

Sijmons,

Maida

et al. 2024

European Journal of Surgical Oncology

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Measuring the quality of care in metastatic colorectal cancer: a scoping review of quality indicators

Dunn,

Halpern,

Sapkaroski

et al. 2024

JNCI Cancer Spectrum

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Background and aims Quality indicators are essential to measure and benchmark the quality of cancer care. Although there are well-established metrics for early-stage colorectal cancer, few exist for advanced colorectal cancer. This scoping review aims to collate and review all quality indicators for metastatic colorectal cancer. Methods A dedicated search was performed of Web of Science, PubMed, CINAHL and relevant grey literature to identify quality indicators for metastatic colorectal cancer, evaluating the diagnostic workup, systemic anticancer treatments, surgical approaches, radiation approaches, supportive care and palliative/terminal care provided to patients. Results We identified 11 articles, of which 5 were systematized reviews and 6 articles concerned the development, validation or operationalization of QIs. Thirty-five distinct QIs for metastatic colorectal cancer were extracted across 6 domains of care: 1) diagnosis, staging and treatment planning, 2) systemic anti-cancer treatment, 3) radiation oncology, 4) surgical approaches, 5) supportive care, 6) palliative and end of life care, with a general QI of overall survival. Of the 35 QIs extracted, 8 (22%) were unique to metastatic CRC, and 27 (77%) were generic QIs across different tumour types but applicable to mCRC. Conclusion and relevance There are few quality indicators specifically relevant to metastatic colorectal cancer. Those that do exist are generally generic process measures used across tumour types, and do not measure the nuance or complexity of current multidisciplinary management of patients with metastatic colorectal cancer.

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Measurement that matters: A systematic review and modified Delphi of multidisciplinary colorectal cancer quality indicators

Cited by 3 publications

References 131 publications

Practice Patterns for Organ Preservation in US Patients With Rectal Cancer, 2006-2020

Practice Patterns for Organ Preservation in US Patients With Rectal Cancer, 2006-2020

Identifying a common data dictionary across colorectal cancer outcome registries: A mapping exercise to identify opportunities for data dictionary harmonisation

Measuring the quality of care in metastatic colorectal cancer: a scoping review of quality indicators

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