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Colorectal Cancer Quality Measures

More than 120 adult residents of Central Minnesota are diagnosed and/or treated for colorectal cancer annually at the Coborn Cancer Center, St. Cloud Hospital or CentraCare Radiation Oncology in Alexandria, Minn. The professionals providing colorectal cancer care are committed to maintaining information about outcomes for patients treated in our cancer program. The data used to analyze the patterns and quality of colorectal cancer care is from the St. Cloud Hospital Registry. The registry collects detailed data about diagnosis and treatment. The aim of the registry is to improve cancer treatment.

The National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines, National Cancer Data Base (NCDB), and peer-reviewed journals were used to identify measures to evaluate colorectal cancer care. The NCDB, a joint program of the Commission on Cancer (CoC) and the American Cancer Society, is a nationwide oncology outcomes database for more than 1,500 CoC approved cancer programs in the United States and Puerto Rico.

The measures below are used to evaluate colorectal cancer care at St. Cloud Hospital:

State at Diagnosis

Measure: Colon and Rectal AJCC Stage at Diagnosis

Rationale: Persons diagnosed and/or treated for colon or rectal cancers at an early stage have a better overall prognosis. Screening by colonoscopy for colorectal cancer is effective and essential in the early detection and treatment of the disease. Reviewing stage at diagnosis data can assist cancer centers in assessing the effectiveness of their screening programs.

Population: Adult men and women treated for colon or rectal cancer at St. Cloud Hospital from 2009 through 2011 were included in this measure. This includes patients seen at St. Cloud Hospital, Coborn Cancer Center and CentraCare Radiation Oncology in Alexandria.

Data Results: The graphs below compare the stage at diagnosis for St. Cloud Hospital colon and rectal cancer cases to statistics from the National Cancer Data Base (NCDB). Stage 0 includes only cases designated as adenocarcinoma in-situ.

Outcome: St. Cloud Hospital’s colon and rectal cancer stage at diagnosis data compares favorably to state and national statistics from the NCDB. St. Cloud Hospital and Coborn Cancer Center have initiated community screening efforts to promote education and early detection.

Quality Graphs Colon Staging© 2012 National Cancer Data Base/Commission 

Quality Graph Rectal Cancer Staging

© 2012 National Cancer Data Base/Commission 

Colonoscopy Evaluation

Measure: Percentage of patients treated with colorectal surgical resections that have a colonoscopy between 6 months before surgery and 6 months after surgery.

Rationale: National guidelines recommend that colorectal cancer patients who undergo surgical resection have a colonoscopy as part of their initial work-up for colorectal cancer. For those patients whose tumor caused obstruction (blockage) and underwent emergency surgery, the guidelines recommend a colonoscopy within 4 to 6 months after their surgery. The purpose of the colonoscopy is to assess the colon for the presence of additional polyps or tumors within the colon or rectum.

Population: Adult men and women undergoing resection for colorectal cancer at St. Cloud Hospital in 2009.

Data Results: Of the 83 patients undergoing a curative colorectal resection at St. Cloud Hospital, 98% (81 patients) underwent a colonoscopy within 6 months before or after surgery. There were 2 patients (2%) who underwent surgery for an obstructing lesion and colonoscopy surveillance was elsewhere.

Outcome: The 98% result is a favorable finding for following national guidelines.

Quality Graph Colorectal Workup

Observed Survival Rates

Measure: Five-year observed survival rate. The cumulative survival rate is equal to the percent of persons alive five years after a colon or rectal cancer diagnosis. It is important to remember that this is the overall survival rate and not just survival from colorectal cancer. Patients may have died of causes other than colorectal cancer.

Rationale: Monitoring survival rates is one of many tools to evaluate the quality of care given by a facility.

Population: Colon and rectal cancer patients who were diagnosed and/or treated at St. Cloud Hospital (including CentraCare Radiation Oncology in Alexandria). The diagnostic years, 2003 through 2005, represent the most current data available to measure survival rates.

Data Results: The graphs below compare the survival rate for St. Cloud Hospital colon and rectal cases to survival rates from the National Cancer Data Base (NCDB).

Outcome: St. Cloud Hospital’s five year survival rates for colon and rectal cancer compare favorably with state and national data.

Quality Graph Colon and Rectal Cancer Survival Rates

© 2012 National Cancer Data Base (NCDB) / Commission on Cancer (CoC)

National Quality Performance Measures

The St. Cloud Hospital Cancer program is accredited by the College of Surgeons Commission on Cancer. The Commission has partnered with the National Quality Forum (NQF), American Society for Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) to provide accredited cancer programs with performance measures and comparison data on an annual basis as a method to assess quality of care. The following measures were developed through this process. It is important to remember that every patient is unique and there may be clinical reasons why a recommended treatment is not the best treatment for the individual.

Adjuvant Chemotherapy (ACT): Stage III Colon Cancer

ACT Measure: Adjuvant chemotherapy is considered or administered within 4 months (120 days) of diagnosis for patients under the age of 80 with AJCC Stage III (lymph node positive) colon cancer.

Rationale: To compare the care of colon cancer patients at St. Cloud Hospital to other Commission on Cancer accredited cancer programs in Minnesota and nationally.

Population: Nine stage III colon cancer patients treated at St Cloud Hospital in 2010 meet the criteria described above.

Outcome: St. Cloud Hospital’s results compare favorably with other accredited cancer programs in Minnesota and nationally.

Quality Graph Colon and Rectal Cancer ACT Measure

© 2012 Commission on Cancer, American College of Surgeons (ACOS) CP3R Reports. The content reproduced from the applications remains the full and exclusive copyrighted property o f the ACOS. The ACOS is not responsible for any ancillary or derivative works based on the original text, tables or figures. Results as of 10/31/2012.

Additional Resources

More people in Minnesota die of colorectal cancer than either breast or prostate cancer. Screening for colorectal cancer offers a measure of early detection and prevention, however less than two-thirds of Minnesotans ages 50 and older report being screened as recommended.

The National Cancer Institute has developed an interactive tool for measuring the risk for colorectal cancer.

Go to the Colorectal Cancer Risk Assessment Tool

For more information about any of the quality measures above, please contact the St. Cloud Hospital Cancer Registry at 320-229-4907.

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