Concordance with NCCN Colorectal Cancer Guidelines and ASCO/NCCN Quality Measures: An NCCN Institutional Analysis

Authors:
Dorothy Romanus From the Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas; Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California; Department of Urology, Ohio State University, Columbus, Ohio; Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York; Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania; and Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.

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Martin R. Weiser From the Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas; Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California; Department of Urology, Ohio State University, Columbus, Ohio; Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York; Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania; and Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.

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John M. Skibber From the Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas; Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California; Department of Urology, Ohio State University, Columbus, Ohio; Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York; Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania; and Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.

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Anna Ter Veer From the Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas; Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California; Department of Urology, Ohio State University, Columbus, Ohio; Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York; Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania; and Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.

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Joyce C. Niland From the Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas; Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California; Department of Urology, Ohio State University, Columbus, Ohio; Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York; Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania; and Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.

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John L. Wilson From the Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas; Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California; Department of Urology, Ohio State University, Columbus, Ohio; Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York; Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania; and Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.

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Ashwani Rajput From the Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas; Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California; Department of Urology, Ohio State University, Columbus, Ohio; Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York; Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania; and Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.

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Yu-Ning Wong From the Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas; Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California; Department of Urology, Ohio State University, Columbus, Ohio; Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York; Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania; and Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.

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Al B. Benson III From the Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas; Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California; Department of Urology, Ohio State University, Columbus, Ohio; Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York; Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania; and Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.

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Stephen Shibata From the Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas; Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California; Department of Urology, Ohio State University, Columbus, Ohio; Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York; Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania; and Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.

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Deborah Schrag From the Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas; Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California; Department of Urology, Ohio State University, Columbus, Ohio; Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York; Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania; and Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.

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Volume/Issue:
Volume 7: Issue 8
Online Publication Date:
Sep 2009
DOI:
https://doi.org/10.6004/jnccn.2009.0059
Full access

Background

The National Comprehensive Cancer Network (NCCN) Outcomes Database was created to assess concordance to evidence- and consensus-based guidelines and to measure adherence to quality measures on an ongoing basis. The Colorectal Cancer Database began in 2005 as a collaboration among 8 NCCN centers.

Methods

Newly diagnosed colon and rectal cancer patients presenting to 1 of 8 NCCN centers between September 1, 2005, and May 21, 2008, were eligible for analysis of concordance with NCCN treatment guidelines for colorectal cancer and with a set of quality metrics jointly developed by ASCO and NCCN in 2007. Adherence rates were determined for each metric. Center-specific rates were benchmarked against mean concordance rates for all participating centers.

Results

A total of 3443 patients were evaluable. Mean concordance rates with NCCN colorectal cancer guidelines and ASCO/NCCN quality measures were generally high (≥ 90%). However, relatively low mean concordance rates were noted for adjuvant chemotherapy treatment recommendations within 9 months of diagnosis of stage II to III rectal cancer (81%), and neoadjuvant chemoradiation in clinical T4 rectal primaries (83%). These low rates of concordance seemed to be consistent across centers.

Conclusions

Adherence to guidelines and quality measures is generally high at institutions participating in the NCCN colorectal cancer database. Lack of documentation, patient refusal, delayed treatment initiation, and lack of consensus about whether treatment was essential were the primary reasons for nonconcordance. Measurement of concordance and the reasons for nonconcordance enable participating centers to understand and improve their care delivery systems.

Correspondence: Deborah Schrag, MD, Department of Adult Oncology, Dana-Farber Cancer Institute, 44 Binney Street, SM 204, Boston, MA 02115. E-mail: deb_schrag@dfci.harvard.edu
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Print ISSN:
1540-1405
Online ISSN:
1540-1413
Publisher:
National Comprehensive Cancer Network
Cover Journal of the National Comprehensive Cancer Network
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Copyright:
Copyright © 2009 by the National Comprehensive Cancer Network 2009
Page Numbers:
10
Article Category:
Research Article
Received:
08 May 2009
Accepted:
23 Jun 2009
Print Publication Date:
01 Sep 2009
Online Publication Date:
Sep 2009
Keywords:
Quality measurement; quality improvement; clinical practice guidelines; colorectal cancer

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