More than 150 adult residents of Central Minnesota are diagnosed and/or treated for
colorectal cancer at the Coborn Cancer Center or St. Cloud Hospital annually. 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 1,400 CoC approved cancer programs in the United States and Puerto Rico.

The measures below are tracked by our Cancer Registry:

Stage at Diagnosis

Colonoscopy Evaluation

Time to Adjuvant Chemotherapy

Observed Survival Rates

Additional Resources

Stage at Diagnosis

Measure: Colon and Rectal AJCC Stage at Diagnosis

Rationale: Persons diagnosed and/or treated for colon or rectal cancer at an early stage have a better overall prognosis. Screening 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 diagnosed and/or treated for colon or rectal cancer at St. Cloud Hospital from 2000 to 2006 were included in this measure. This includes patients seen at St. Cloud Hospital, Coborn Cancer Center, and the Alexandria Radiation Oncology Unit.

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). The NCDB data is from 1,340 cancer registries.

Outcome: St. Cloud Hospital’s colon cancer stage at diagnosis data compares favorably to national statistics from the NCDB. Rectal cancer stage at diagnosis at St. Cloud Hospital indicates that a higher number of rectal cancer cases are diagnosed at a later stage (stage II to IV) when compared to national data. This may be a result of St. Cloud Hospital and Coborn Cancer Center being a resource in the region for patients with more advanced cancer. St. Cloud Hospital and Coborn Cancer Center have initiated community screening efforts to promote education and early detection.

© Commission on Cancer, American College of Surgeons (ACOS). NCDB Benchmark Reports, v9.0. Chicago, IL, 2008. The content reproduced from the applications remains the full and exclusive copyrighted property of the ACOS. The ACOS is not responsible for any ancillary or derivative works based on the original Text, Tables or Figures.

© Commission on Cancer, American College of Surgeons (ACOS). NCDB Benchmark Reports, v9.0. Chicago, IL, 2008. The content reproduced from the applications remains the full and exclusive copyrighted property of the ACOS. The ACOS is not responsible for any ancillary or derivative works based on the original Text, Tables or Figures.

Colonoscopy Evaluation

Measure: Percentage of patients treated with colorectal surgical resection who 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 or barium enema 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 2007.

Data Results: Of the 102 patients with follow-up data in the cancer registry, 100 or 98% underwent a pre-operative colonoscopy between 6 months before surgery and 6 months after surgery. There were 2 patients (2%) who underwent colon surgery for obstruction and had their colonoscopy greater than 6 months after their surgery.

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

Time to Adjuvant Chemotherapy

Measure: Adjuvant chemotherapy will be administered within 56 days of surgery for stage III colon cancer patients.

Rationale: Adjuvant (post-operative) chemotherapy is given to destroy any remaining cancer cells. This is done to reduce the chance of reoccurrence, to increase the cure rate, and therefore improve chances of long-term survival from colon cancer. Some studies have shown that delaying chemotherapy can reduce the maximum benefit it can give. Although treatment guidelines do not give a specific time interval in which the adjuvant chemotherapy should be given, several articles in the literature recommended that adjuvant chemotherapy be given within 56 days after surgery for stage III colon cancer patients.

Population: In the years 2004 to 2007, 45 adult men and women underwent surgical intervention for stage III colon cancer followed by adjuvant chemotherapy at Coborn Cancer Center.

Data Results: For the years 2004 to 2007, the number below depicts the average number of days by year from the surgery date to the start of chemotherapy. The average number of days between surgery and the start of chemotherapy per year ranged from 44.3 to 47.8 days.

Outcome: Adjuvant chemotherapy for stage III colon cancer was started an average of 46 days after surgery for the years 2004 to 2007. This is well within the 56 days suggested in the literature. There were nine patients who received chemotherapy greater than 56 days after surgery, all due to surgical complications, patient choice, or delays related to entering clinical trials.

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.

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

Population: Colon or rectal cancer patients who were diagnosed and/or treated at St. Cloud Hospital (including Alexandria Radiation Unit) from 1998-2001 were included in this study. The NCDB data is from 1300 national hospital cancer registries. The diagnostic years, 1998-2001, 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 NCDB.

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

© Commission on Cancer, American College of Surgeons (ACOS). Chicago, IL, 2009. The content reproduced from the applications remains the full and exclusive copyrighted property of the ACOS. The ACOS is not responsible for any ancillary or derivative works based on the original Text, Tables or Figures.

© Commission on Cancer, American College of Surgeons (ACOS). Chicago, IL, 2009. The content reproduced from the applications remains the full and exclusive copyrighted property of the ACOS. The ACOS is not responsible for any ancillary or derivative works based on the original Text, Tables or Figures.

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.
View the report: Minnesota Cancer Facts and Figures 2009 from the Minnesota Cancer Alliance

The National Cancer Institute has developed an interactive tool for measuring the risk for colorectal cancer.
Go to the Colorectal Cancer Risk Assessment Tool

Visit our health library to learn more about:

• Colorectal cancer
• Colon cancer
• Rectal cancer

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