HSR20-102: Quality Outcomes in Colon Cancer

A retrospective review of 104 patients with non-metastatic, stage II-III colon cancer from 1/1/2015 to 12/31/2018 at a community based cancer center was performed to determine NCCN guideline adherence during pre-operative and post-operative management. Patients with stage II colon cancer were further subdivided into low and high-risk categories on the basis of ASCO and NCCN guidelines. Demographics and histology were not statistically significant between stage II low risk, high risk and stage III patients. Adherence to adequate pre and post- operative evaluation including labs (CBC, CMP, CEA) and imaging was between 74-93%. Curative surgeries with adequate negative margins and at least 12 lymph nodes for staging were performed in 79-100% of patients based on staging. In all cases, traditional TNM staging was reported with approximately 88-95% of tumors also being tested for microsatellite instability (MSI). Patients with MSI low tumors are high-risk and should get adjuvant treatment; however, only 6.3% of high risk stage II and 45.5% of stage III patients received adjuvant therapy. Data showed 100% compliance with initiation of adjuvant 5-FU based chemotherapy within 12 weeks post surgery, which is recommended in high risk stage II and III colon cancer; however, overall adherence to guidelines was only at 11% for high risk stage II colon cancer patients being treated (Figure 1) . Conversely, 84% of stage II low risk and 72% of stage III patients received treatment per guidelines. 71% of high risk stage II patients and 19% of stage III patients were offered chemotherapy; however, the patients refused. 8% of high risk stage II patients and 38% of stage III patients were lost to follow up. Chemotherapy was not recommended in 4% of high risk stage II patients and 25% of stage III patients due to comorbidities. Studies have demonstrated that adherence to NCCN guidelines improves survival rate in patients with colon cancer. Our study results are comparable to that of other published studies examining compliance with guidelines for colon cancer. We will initiate a checklist to identify high-risk patients and enhance our multidisciplinary approach to improve upon our compliance with stage II-III colon cancer NCCN guidelines. Future studies evaluating NCCN guideline adherence after implementing the new checklist and multidisciplinary clinic will be conducted with the final endpoint being overall survival of patients.

Figure 1
Figure 1

Chemotherapy and Treatment

Citation: Journal of the National Comprehensive Cancer Network J Natl Compr Canc Netw 18, 3.5; 10.6004/jnccn.2019.7457

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Corresponding Author: Michelle Moskal
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