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Udayasiri DK, MacCallum C, Da Silva N, Skandarajah A, Hayes IP. Impact of hospital geographic remoteness on overall survival after colorectal cancer resection using state-wide administrative data. ANZ J Surg 2020; 90:1321-1327. [PMID: 32496014 DOI: 10.1111/ans.15991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study aimed to use administrative data (AD) linked to the Victorian death index (VDI) to report on overall long-term survival following colorectal cancer (CRC) surgery, comparing regional to metropolitan hospitals. METHODS A retrospective cohort study using prospectively gathered AD linked to VDI. The primary outcome was overall survival (OS). Outcomes were adjusted for potential confounders via multivariable Cox proportional hazard regression analysis. RESULTS Total of 17 533 patients: 12 879 metropolitan patients, 3835 inner regional patients and 719 outer regional patients. Multivariable Cox regression, adjusted for the effects of age, ASA score, Charlson score, position of tumour, mode of access, admission type, lymph node metastases, distant metastases, return to theatre, length of stay, HDU admission and discharge destination showed no difference in OS comparing CRC resection patients from inner or outer regional hospitals to metropolitan ((HR 1.02, 95% CI 0.95-1.09, P = 0.59) and (HR 0.97, 95% CI 0.85-1.11, P = 0.68) respectively). CONCLUSION This is the largest and most detailed study concerning OS after CRC resection involving Victorian public hospitals. There was no difference in OS following CRC resection when inner or outer regional hospitals were compared to metropolitan hospitals in Victoria. The study demonstrated the utility of AD with validated algorithms, linked to death data for reporting CRC survival outcomes.
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Affiliation(s)
- Dilshan K Udayasiri
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline MacCallum
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nigel Da Silva
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anita Skandarajah
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ian P Hayes
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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Udayasiri DK, MacCallum C, Silva ND, Skandarajah A, Hayes IP. Impact of hospital geographic remoteness on short-term outcomes after colorectal cancer resection using state-wide administrative data. ANZ J Surg 2020; 90:1328-1334. [PMID: 32455508 DOI: 10.1111/ans.15992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND This study aimed to use validated coding algorithms, applied to a central repository of administrative data (AD), to report on short-term outcomes following resection for colorectal cancer (CRC) comparing regional to metropolitan Victorian hospitals. METHODS This is a retrospective cohort study using prospectively gathered AD. The primary outcome was prolonged length of stay (LOS). Secondary outcomes were: inpatient mortality, return to theatre, discharge destination and need for mechanical ventilation/intensive care unit support. Outcomes were adjusted for potential confounders via multivariable logistic regression analysis. RESULTS This study of 18 470 patients found strong evidence for lower odds of prolonged LOS (odds ratio (OR) 0.53, 95% confidence interval (CI) 0.48-0.58, P ≤ 0.001) and inpatient mortality (OR 0.67, 95% CI 0.49-0.91, P = 0.01) in inner regional hospital compared with metropolitan hospitals. For outer regional hospitals, there was strong evidence of decreased odds of prolonged LOS (OR 0.64, 95% CI 0.52-0.77, P = <0.001) and return to theatre (OR 0.67, 95% CI 0.47-0.95, P = 0.03). CONCLUSION This is the largest and most detailed study concerning short-term outcomes following CRC resection in Victorian public hospitals. Inner and outer regional centres had similar or better short-term outcomes than metropolitan hospitals after CRC resection. AD with validated algorithms serves as a large accurate database to report on CRC outcomes.
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Affiliation(s)
- Dilshan K Udayasiri
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline MacCallum
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nigel Da Silva
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anita Skandarajah
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ian P Hayes
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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Ngune I, Jiwa M, McManus A, Parsons R, Pagey G, Hodder R. Do Patients Treated for Colorectal Cancer Benefit from General Practitioner Support? A Video Vignette Study. J Med Internet Res 2015; 17:e249. [PMID: 26541077 PMCID: PMC4642383 DOI: 10.2196/jmir.4942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 08/22/2015] [Accepted: 09/22/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients who have been treated for colorectal cancer in Australia can consult their general practitioner (GP) for advice about symptoms or side effects at any time following their treatment. However, there is no evidence that such patients are consistently advised by GPs, and patients experience substantial unmet need for reassurance and advice. OBJECTIVE To explore the patient management options selected by GPs to treat a set of patients describing their symptoms following treatment for colorectal cancer. METHODS This was an Internet-based survey. Participants (GPs) viewed 6 video vignettes of actors representing patients who had been treated for colorectal cancer. The actor-patients presented problems that resulted from their treatment. Participants indicated their diagnosis and stated if they would prescribe, refer, or order tests, based on that diagnosis. These responses were then rated against the management decisions for those vignettes as recommended by a team of colorectal cancer experts. RESULTS In total, 52 GPs consented to take part in the study, and 40 (77%) completed the study. Most GPs made a diagnosis of colorectal cancer treatment side effects/symptoms of recurrence that was consistent with the experts' opinions. However, correct diagnosis was dependent on the type of case viewed. Compared with radiation proctitis, GPs were more likely to recognize peripheral neuropathy (odds ratio, OR, 4.43, 95% CI 1.41-13.96, P=.011) and erectile dysfunction (OR 9.70, 95% CI 2.48-38.03, P=.001), but less likely to identify chemotherapy-induced fatigue (OR 0.19, 95% CI 0.08-0.44). GPs who had more hours of direct patient care (OR 0.38, 95% CI 0.17-0.84, P=.02), were experienced (OR 9.78, 95% CI 1.18-8.84, P=.02), and consulted more patients per week (OR 2.48, 95% CI 1.16-5.30, P=.02) suggested a management plan that was consistent with the expert opinion. CONCLUSIONS In this pilot study, years of experience and direct patient contact hours had a significant and positive impact on the management of patients. This study also showed promising results indicating that management of the common side effects of colorectal cancer treatment can be delegated to general practice. Such an intervention could support the application of shared models of care. However, a larger study, including the management of side effects in real patients, needs to be conducted before this can be safely recommended.
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Affiliation(s)
- Irene Ngune
- Faculty of Health, Engineering and Science, Edith Cowan University, Perth, Australia.
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Dobbins TA, Badgery-Parker T, Currow DC, Young JM. Assessing measures of comorbidity and functional status for risk adjustment to compare hospital performance for colorectal cancer surgery: a retrospective data-linkage study. BMC Med Inform Decis Mak 2015; 15:55. [PMID: 26174550 PMCID: PMC4502567 DOI: 10.1186/s12911-015-0175-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 06/26/2015] [Indexed: 11/12/2022] Open
Abstract
Background Comparing outcomes between hospitals requires consideration of patient factors that could account for any observed differences. Adjusting for comorbid conditions is common when studying outcomes following cancer surgery, and a commonly used measure is the Charlson comorbidity index. Other measures of patient health include the ECOG performance status and the ASA physical status score. This study aimed to ascertain how frequently ECOG and ASA scores are recorded in population-based administrative data collections in New South Wales, Australia and to assess the contribution each makes in addition to the Charlson comorbidity index in risk adjustment models for comparative assessment of colorectal cancer surgery outcomes between hospitals. Methods We used linked administrative data to identify 6964 patients receiving surgery for colorectal cancer in 2007 and 2008. We summarised the frequency of missing data for Charlson comorbidity index, ECOG and ASA scores, and compared patient characteristics between those with and without these measures. The performance of ASA and ECOG in risk adjustment models that also included Charlson index was assessed for three binary outcomes: 12-month mortality, extended length of stay and 28-day readmission. Patient outcomes were compared between hospital peer groups using multilevel logistic regression analysis. Results The Charlson comorbidity index could be derived for all patients, ASA score was recorded for 78 % of patients and ECOG performance status recorded for only 24 % of eligible patients. Including ASA or ECOG improved the predictive ability of models, but there was no consistently best combination. The addition of ASA or ECOG did not substantially change parameter estimates for hospital peer group after adjusting for Charlson comorbidity index. Conclusions While predictive ability of regression models is maximised by inclusion of one or both of ASA score and ECOG performance status, there is little to be gained by adding ASA or ECOG to models containing the Charlson comorbidity index to address confounding. The Charlson comorbidity index has good performance and is an appropriate measure to use in risk adjustment to compare outcomes between hospitals. Electronic supplementary material The online version of this article (doi:10.1186/s12911-015-0175-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Timothy A Dobbins
- Cancer Epidemiology and Services Research, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Tim Badgery-Parker
- Cancer Epidemiology and Services Research, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Cancer Institute NSW, Sydney, NSW, Australia.,Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | - Jane M Young
- Cancer Epidemiology and Services Research, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia. .,Cancer Institute NSW, Sydney, NSW, Australia. .,Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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Uptake and outcomes of laparoscopically assisted resection for colon and rectal cancer in Australia: a population-based study. Dis Colon Rectum 2014; 57:415-22. [PMID: 24608296 DOI: 10.1097/dcr.0000000000000060] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Meta-analyses of randomized controlled trials support the use of laparoscopically assisted resection for colon cancer. The evidence supporting its use in rectal cancer is weak. OBJECTIVE The purpose of this work was to investigate the uptake of laparoscopically assisted resection for colon and rectal cancer and to compare short- and long-term outcomes using population data. DESIGN This was a retrospective cohort study using linked administrative health data. SETTINGS The study encompassed all of the public and private hospitals in New South Wales, Australia, between 2000 and 2008. PATIENTS A total of 27,947 patients with colon or rectal cancer undergoing surgery with curative intent were included in the study. MAIN OUTCOME MEASURES We summarized the proportion of resections performed laparoscopically. Short-term outcomes were extended stay, 28-day readmission, 28-day emergency readmission, 30- and 90-day mortality, and 90-day readmission with pulmonary embolism or deep-vein thrombosis. Long-term outcomes were all-cause and cancer-specific death and admission with obstruction or incisional hernia repair. RESULTS Laparoscopic procedures increased between 2000 and 2008 for colon (1.5%-20.7%) and rectal cancer (0.6%-15.5%). Laparoscopic procedures reduced rates of extended stay (OR, 0.60; 95% CI, 0.49-0.72) and 28-day readmission (OR, 0.86; 95% CI, 0.74-0.99) for colon cancer. For rectal cancer, laparoscopic procedures had lower rates of 28-day readmission (OR, 0.58; 95% CI, 0.42-0.78) and 28-day emergency readmission (OR, 0.54; 95% CI, 0.34-0.85). Laparoscopic procedures improved cancer-specific survival for rectal cancer (HR, 0.71; 95% CI, 0.51-1.00). Survival benefits were observed for laparoscopically assisted colon resection in higher-caseload hospitals but not lower-caseload hospitals. LIMITATIONS It was not possible to identify laparoscopically assisted resections converted to open procedures because of the claims-based nature of the data. CONCLUSIONS Despite increases in laparoscopically assisted resections for colon and rectal cancer, the majority of resections are still treated by open procedures. Our data suggest that laparoscopic resection reduces the lengths of stay and rates of readmission and may result in improved cancer-specific survival for both colon and rectal resections.
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The first 1000 patients on an internet-based colorectal neoplasia database across private and public medicine in Australia: development of a binational model for the Colorectal Surgical Society of Australia and New Zealand. Dis Colon Rectum 2014; 57:167-73. [PMID: 24401877 DOI: 10.1097/dcr.0000000000000041] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Collection of multi-institutional data pertaining to the treatment of bowel cancer has been hindered by poor clinician compliance with data entry and the lack of incentive to participate. OBJECTIVE This study aimed to establish if a novel browser-based model of data collection results in complete data capture. DESIGN A Web-based data collection interface was custom written, offering automated reporting modules for clinical outcome to participants and an automated reporting system for outstanding data fields, and summary reporting of surgical quality outcomes. The software was combined with a clinical feedback system incorporating fortnightly data review meetings, at the time of clinical multidisciplinary meetings. PATIENTS AND SETTING Selected were 932 consecutive patients with opt-out consent from 3 hospital sites, including public and private medicine. MAIN OUTCOME MEASURES The primary outcomes measured were the analysis of data completeness and accuracy and ensuring that the highest-quality data were used for clinical audit of the surgical practices of Australian colorectal surgeons for the purpose of quality assurance. RESULTS A total of 932 men and women, 22 to 94 years of age, treated for colorectal neoplasia were evaluated. We obtained 100% completion (>27,000 data points) of perioperative data registered by 8 specialist colorectal surgeons and a full-time database manager. CONCLUSIONS Data completeness and validity are essential for clinical databases to serve the purpose of quality assurance, benchmarking, and research. The results confirm the safety and efficacy of colorectal cancer surgery in both the public and private sector in Australia. The combination of a simple multiuser interface, defined data points, automated result-reporting modules, and data-deficiency reminder module resulted in 100% data compliance in nearly 1000 clinical episodes. The unprecedented success of this model has lead to the Colorectal Surgical Society of Australia and New Zealand adopting this model for data collection for Australia and New Zealand as the binational database.
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Stavrou E, Pesa N, Pearson SA. Hospital discharge diagnostic and procedure codes for upper gastro-intestinal cancer: how accurate are they? BMC Health Serv Res 2012; 12:331. [PMID: 22995224 PMCID: PMC3506480 DOI: 10.1186/1472-6963-12-331] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 09/13/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Population-level health administrative datasets such as hospital discharge data are used increasingly to evaluate health services and outcomes of care. However information about the accuracy of Australian discharge data in identifying cancer, associated procedures and comorbidity is limited. The Admitted Patients Data Collection (APDC) is a census of inpatient hospital discharges in the state of New South Wales (NSW). Our aim was to assess the accuracy of the APDC in identifying upper gastro-intestinal (upper GI) cancer cases, procedures for associated curative resection and comorbidities at the time of admission compared to data abstracted from medical records (the 'gold standard'). METHODS We reviewed the medical records of 240 patients with an incident upper GI cancer diagnosis derived from a clinical database in one NSW area health service from July 2006 to June 2007. Extracted case record data was matched to APDC discharge data to determine sensitivity, positive predictive value (PPV) and agreement between the two data sources (κ-coefficient). RESULTS The accuracy of the APDC diagnostic codes in identifying site-specific incident cancer ranged from 80-95% sensitivity. This was comparable to the accuracy of APDC procedure codes in identifying curative resection for upper GI cancer. PPV ranged from 42-80% for cancer diagnosis and 56-93% for curative surgery. Agreement between the data sources was >0.72 for most cancer diagnoses and curative resections. However, APDC discharge data was less accurate in reporting common comorbidities - for each condition, sensitivity ranged from 9-70%, whilst agreement ranged from κ = 0.64 for diabetes down to κ < 0.01 for gastro-oesophageal reflux disorder. CONCLUSIONS Identifying incident cases of upper GI cancer and curative resection from hospital administrative data is satisfactory but under-ascertained. Linkage of multiple population-health datasets is advisable to maximise case ascertainment and minimise false-positives. Consideration must be given when utilising hospital discharge data alone for generating comorbidity indices, as disease burden at the time of admission is under-reported.
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Affiliation(s)
- Efty Stavrou
- Adult Cancer Program, Prince of Wales Clinical School, Lowy Cancer Research Centre, University of New South Wales, Sydney, NSW, Australia.
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White SI, Wright D, Taylor CJ. A comparison of laparoscopic versus open rectal surgery in 114 consecutive octogenarians. Colorectal Dis 2012; 14:e395-9. [PMID: 22288556 DOI: 10.1111/j.1463-1318.2012.02963.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM The study is a retrospective review of the short-term outcome of all elective rectal resections in 114 consecutive octogenarian patients during the 10-year period January 2000 to December 2009. METHOD Sixty laparoscopic and 54 open resections were completed. The two groups were evenly matched for age (mean 83 years), American Society of Anesthesiologists score (mean 2.5) and pathology (malignancy 60%). RESULTS Morbidity and mortality were comparable with no significant differences. Only length of stay in uncomplicated recoveries was significantly different in favour of laparoscopic surgery at 10 vs 14 days, P < 0.003. CONCLUSION Laparoscopic rectal resection is suitable for octogenarians.
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Affiliation(s)
- S I White
- Department of General Surgery, Tweed Hospital, Tweed Heads, New South Wales, Australia.
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Schellerer VS, Merkel S, Schumann SC, Schlabrakowski A, Förtsch T, Schildberg C, Hohenberger W, Croner RS. Despite aggressive histopathology survival is not impaired in young patients with colorectal cancer : CRC in patients under 50 years of age. Int J Colorectal Dis 2012; 27:71-9. [PMID: 21881876 DOI: 10.1007/s00384-011-1291-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2011] [Indexed: 02/04/2023]
Abstract
PURPOSE Colorectal carcinoma (CRC) is generally a disease of persons older than 50 years. Concerning younger patients, controversies still exist regarding features and prognosis of CRC. We performed this study to characterize CRC in young patients (≤50 years) as well as to evaluate outcome in comparison with older patients (>50 years) with CRC. METHODS Clinical and histopathological parameters of 244 patients aged 50 years or less were compared with 1,718 patients aged more than 50 years. RESULTS Compared with older patients, the younger had less adenocarcinomas (82.8% vs. 89.1%; p = 0.004) and less postoperative complications (18.4% vs. 28.7%; p = 0.001), and less Union Internationale Contre le Cancer stage I colon cancers (22.9% vs. 13.6%, p = 0.046) but elevated overall 5-year survival rates for M0 colon and rectal cancers (p = 0.005; p < 0.001). In young patients, the minority suffered from hereditary cancer syndromes (7.4%) and inflammatory bowel diseases (7.0%). Furthermore, up to 40% of young patients denied any cancers in their families. Cancer-related survival rates were significantly elevated in young patients with M0 rectal carcinoma (p = 0.014), whereas in M0 colon cancers, no differences were detectable (p = 0.542). In case of the presence of distant metastases, overall and cancer-related survival rates were similar in old and young patients. CONCLUSION Although young patients present with more aggressive histopathological subtypes and less early stages, cancer-related survival is not less favourable compared with older patients.
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Affiliation(s)
- Vera Simone Schellerer
- Department of Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany.
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Goldsbury DE, Smith DP, Armstrong BK, O'Connell DL. Using linked routinely collected health data to describe prostate cancer treatment in New South Wales, Australia: a validation study. BMC Health Serv Res 2011; 11:253. [PMID: 21978077 PMCID: PMC3206422 DOI: 10.1186/1472-6963-11-253] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 10/06/2011] [Indexed: 11/15/2022] Open
Abstract
Background Population-based patterns of care studies are important for monitoring cancer care but conducting them is expensive and resource-intensive. Linkage of routinely collected administrative health data may provide an efficient alternative. Our aim was to determine the accuracy of linked routinely collected administrative data for monitoring prostate cancer care in New South Wales (NSW), Australia. Methods The NSW Prostate Cancer Care and Outcomes Study (PCOS), a population-based survey of patterns of care for men aged less than 70 years diagnosed with prostate cancer in NSW, was linked to the NSW Cancer Registry, electronic hospital discharge records and Medicare and Pharmaceutical claims data from Medicare Australia. The main outcome measures were treatment with radical prostatectomy, any radiotherapy, external beam radiotherapy, brachytherapy or androgen deprivation therapy, and cancer staging. PCOS data were considered to represent the true treatment status. The sensitivity and specificity of the administrative data were estimated and relevant patient characteristics were compared using chi-squared tests. Results The validation data set comprised 1857 PCOS patients with treatment information linked to Cancer Registry records. Hospital and Medicare claims data combined described treatment more accurately than either one alone. The combined data accurately recorded radical prostatectomy (96% sensitivity) and brachytherapy (93% sensitivity), but not androgen deprivation therapy (76% sensitivity). External beam radiotherapy was rarely captured (5% sensitivity), but this was improved by including Medicare claims for radiation field setting or dosimetry (86% sensitivity). False positive rates were near 0%. Disease stage comparisons were limited by one-third of cases having unknown stage in the Cancer Registry. Administrative data recorded treatment more accurately for cases in urban areas. Conclusions Cancer Registry and hospital inpatient data accurately captured radical prostatectomy and brachytherapy treatment, but not external beam radiotherapy or disease stage. Medicare claims data substantially improved the accuracy with which all major treatments were recorded. These administrative data combined are valid for population-based studies of some aspects of prostate cancer care.
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Affiliation(s)
- David E Goldsbury
- Cancer Epidemiology Research Unit, Cancer Council NSW, PO Box 572, Kings Cross, NSW 1340, Australia.
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11
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Nadathur SG. Maximising the value of hospital administrative datasets. AUST HEALTH REV 2010; 34:216-23. [PMID: 20497736 DOI: 10.1071/ah09801] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 11/25/2009] [Indexed: 11/23/2022]
Abstract
Mandatory and standardised administrative data collections are prevalent in the largely public-funded acute sector. In these systems the data collections are used for financial, performance monitoring and reporting purposes. This paper comments on the infrastructure and standards that have been established to support data collection activities, audit and feedback. The routine, local and research uses of these datasets are described using examples from Australian and international literature. The advantages of hospital administrative datasets and opportunities for improvement are discussed under the following headings: accessibility, standardisation, coverage, completeness, cost of obtaining clinical data, recorded Diagnostic Related Groups and International Classification of Diseases codes, linkage and connectivity. In an era of diminishing resources better utilisation of these datasets should be encouraged. Increased study and scrutiny will enhance transparency and help identify issues in the collections. As electronic information systems are increasingly embraced, administrative data collections need to be managed as valuable assets and powerful operational and patient management tools.
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Affiliation(s)
- Shyamala G Nadathur
- Department of Medicine, Monash Medical Centre, Monash University, Clayton, VIC 3168, Australia.
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Bujanda L, Sarasqueta C, Hijona E, Hijona L, Cosme A, Gil I, Elorza JL, Asensio JI, Larburu S, Enríquez-Navascués JM, Jover R, Balaguer F, Llor X, Bessa X, Andreu M, Paya A, Castells A, Association GOGOTSG. Colorectal cancer prognosis twenty years later. World J Gastroenterol 2010; 16:862-867. [PMID: 20143465 PMCID: PMC2825333 DOI: 10.3748/wjg.v16.i7.862] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 10/02/2009] [Accepted: 10/09/2009] [Indexed: 02/07/2023] Open
Abstract
AIM To evaluate changes in colorectal cancer (CRC) survival over the last 20 years. METHODS We compared two groups of consecutive CRC patients that were prospectively recruited: Group I included 1990 patients diagnosed between 1980 and 1994. Group II included 871 patients diagnosed in 2001. RESULTS The average follow up time was 21 mo (1-229) for Group I and 50 mo (1-73.4) for Group II. Overall median survival was significantly longer in Group II than in Group I (73 mo vs 25 mo, P < 0.001) and the difference was significant for all tumor stages. Post surgical mortality was 8% for Group Iand 2% for Group II (P < 0.001). Only 17% of GroupI patients received chemotherapy compared with 50% of Group II patients (P < 0.001). CONCLUSION Survival in colorectal cancer patients has doubled over the past 20 years. This increase seems to be partly due to the generalization in the administration of chemotherapy and to the decrease of post surgical mortality.
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Gordon LG, Obermair A. Potential hospital cost-savings attributed to improvements in outcomes for colorectal cancer surgery following self-audit. BMC Surg 2010; 10:4. [PMID: 20105290 PMCID: PMC2835671 DOI: 10.1186/1471-2482-10-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 01/27/2010] [Indexed: 01/16/2023] Open
Abstract
Background One of the potential benefits of surgical audit is improved hospital cost-efficiencies arising from lower resource consumption associated with fewer adverse events. The aim of this study was to estimate the potential cost-savings for Australian hospitals from improved surgical performance for colorectal surgery attributed to a surgical self-audit program. Methods We used a mathematical decision-model to investigate cost differences in usual practice versus surgical audit and synthesized published hospital cost data with epidemiological evidence of adverse surgical events in Australia and New Zealand. A systematic literature review was undertaken to assess post-operative outcomes from colorectal surgery and effectiveness of surgical audit. Results were subjected to both one-way and probabilistic sensitivity analyses to address uncertainty in model parameters. Results If surgical self-audit facilitated the reduction of adverse surgical events by half those currently reported for colorectal cancer surgery, the potential cost-savings to hospitals is AU$48,720 (95% CI: $18,080-$89,260) for each surgeon treating 20 cases per year. A smaller 25% reduction in adverse events produced cost-savings of AU$24,960 per surgeon (95%CI: $1,980-$62,980). Potential hospital savings for all operative colorectal cancer cases was estimated at AU$30.3 million each year. Conclusions Surgical self-audit has the potential to create substantial hospital cost-savings for colorectal cancer surgery in Australia when considering the widespread incidence of this disease. The study is limited by the current availability and quality of data estimates abstracted from the published literature. Further evidence on the effectiveness of self-audit is required to substantiate these findings.
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Affiliation(s)
- Louisa G Gordon
- Queensland Institute of Medical Research, Genetics and Population Health Division, PO Royal Brisbane Hospital, Herston Q4029, Brisbane, Australia.
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[Postoperative mortality risk factors in colorectal cancer: follow up of a cohort in a specialised unit]. Cir Esp 2009; 87:101-7. [PMID: 19963211 DOI: 10.1016/j.ciresp.2009.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 09/09/2009] [Accepted: 09/09/2009] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The treatment of colorectal cancer (CRC) is usually surgical and involves morbidity-mortality. The aim of this study is to quantify the postoperative mortality in our hospital and to determine their risk factors. MATERIALS AND METHODS Prospective observational study from 1996 to 2007 included 1017 patients who underwent surgery for CRC in our hospital. Identification of independent risk factors for postoperative mortality by multivariate analysis. RESULTS The mean age was 67.8 years. The surgery was elective in 879 (86.5%) and was considered curative in 878 (86.1%). The postoperative mortality was 3.6% (37 patients), 2.5% in the elective surgery and 10.9% in the urgent. The independent risk factors identified were: type of surgery (odds ratio for urgent vs. elective=2.8), American Society of Anesthesiologists (ASA) grade (odds ratio for ASA III-IV vs. I-II=2.4), age (odds ratio for age > or = 85 vs. < or = 74=7.6 and age 75-84 vs. < or = 74=2.4). CONCLUSIONS We found a low postoperative mortality, which was mainly associated with age over 75 years, ASA III or IV stages and urgent surgery.
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Shafik AA, Asaad S, Loka MM, Wahdan M, Shafik A. Colosigmoid junction: morphohistologic, morphometric, and endoscopic study with identification of colosigmoid canal with sphincter. Clin Anat 2009; 22:243-9. [PMID: 19089999 DOI: 10.1002/ca.20738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
To study the anatomical structure of the colosigmoid junction, 15 cadaveric specimens were studied morphologically, another 15 histologically, and a morphometric study was done in 10 specimens. Specimens consisted of the descending colon, sigmoid colon, and the colosigmoid junction. Histologic specimens were stained with hematoxylin and eosin and Masson's trichrome stain. Morphometric studies used an image analysis system. The colosigmoid junction was investigated endoscopically in 18 healthy volunteers. A narrow segment having a mean length of 5.2 +/- 1.1 cm was identified both externally and internally between the descending and sigmoid colon. We called this segment the colosigmoid canal. Mucosal folds were found crowded in the colosigmoid canal, the lower end of which formed a nipple and was surrounded by a fornix. Histologically, the colosigmoid canal mucosa showed multiple folds. Its circular muscle was thicker than that of the descending or the sigmoid colon and confirmed morphometrically. The longitudinal muscle was thicker in only 4 of 10 specimens. Both the narrowing and the mucosal crowding were verified endoscopically. The colosigmoid junction is the narrow segment between the descending and the sigmoid colon. Histologic, morphometric and endoscopic studies indicated the presence of a sphincter in the colosigmoid canal. A colosigmoid sphincter is suggested to control the passage of colonic contents from the descending colon to the colosigmoid canal as well as to prevent reflux of sigmoid contents into the descending colon.
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Affiliation(s)
- Ali A Shafik
- Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt
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Ulrich A, Weitz J, Slodczyk M, Koch M, Jaeger D, Münter M, Büchler MW. Neoadjuvant treatment does not influence perioperative outcome in rectal cancer surgery. Int J Radiat Oncol Biol Phys 2009; 75:129-36. [PMID: 19304407 DOI: 10.1016/j.ijrobp.2008.10.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2008] [Revised: 10/26/2008] [Accepted: 10/30/2008] [Indexed: 12/17/2022]
Abstract
PURPOSE To identify the risk factors for perioperative morbidity in patients undergoing resection of primary rectal cancer, with a specific focus on the effect of neoadjuvant therapy. METHODS AND MATERIALS This exploratory analysis of prospectively collected data included all patients who underwent anterior resection/low anterior resection or abdominoperineal resection for primary rectal cancer between October 2001 and October 2006. The study endpoints were perioperative surgical and medical morbidity. Univariate and multivariate analyses of potential risk factors were performed. RESULTS A total of 485 patients were included in this study; 425 patients (88%) underwent a sphincter-saving anterior resection/low anterior resection, 47 (10%) abdominoperineal resection, and 13 (2%) multivisceral resection. Neoadjuvant chemoradiotherapy was performed in 100 patients (21%), and 168 (35%) underwent neoadjuvant short-term radiotherapy (5 x 5 Gy). Patient age and operative time were independently associated with perioperative morbidity, and operative time, body mass index >27 kg/m(2) (overweight), and resection type were associated with surgical morbidity. Age and a history of smoking were confirmed as independent prognostic risk factors for medical complications. Neoadjuvant therapy was not associated with a worse outcome. CONCLUSION The results of this prospective study have identified several risk factors associated with an adverse perioperative outcome after rectal cancer surgery. In addition, neoadjuvant therapy was not associated with increased perioperative complications.
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Affiliation(s)
- Alexis Ulrich
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
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Abstract
Collections of routine, or ‘administrative’, hospital data have many applications in health care and are now recognised as valuable sources of information. In recent decades, administrative data have been seen primarily as funding and billing tools to assist with the reimbursement of hospitals for services provided; this purpose remains the primary focus of the clinical coder workforce. More recently, hospital data have been recognised as valuable resources for a range of health system improvement processes beyond funding. The focus of this paper is to review and demonstrate the diverse uses of administrative data in health services research and quality improvement. By gaining an understanding of how the data are used, we can appreciate the importance of good quality data from the perspective of its multiple uses. This paper describes a sample of the studies conducted in Australia using administrative data in health care improvement.
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Affiliation(s)
- Jude L Michel
- Jude L Michel BHIthlnfoManagt(Hons), Australian Centre for Economic Research on Health, (ACERH), School of Medicine, University of Queensland, Herston Road, Herston, Brisbane 4006 QLD, AUSTRALIA
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Asteria CR, Gagliardi G, Pucciarelli S, Romano G, Infantino A, La Torre F, Tonelli F, Martin F, Pulica C, Ripetti V, Diana G, Amicucci G, Carlini M, Sommariva A, Vinciguerra G, Poddie DB, Amato A, Bassi R, Galleano R, Veronese E, Mancini S, Pescio G, Occelli GL, Bracchitta S, Castagnola M, Pontillo T, Cimmino G, Prati U, Vincenti R. Anastomotic leaks after anterior resection for mid and low rectal cancer: survey of the Italian Society of Colorectal Surgery. Tech Coloproctol 2008; 12:103-10. [PMID: 18545882 DOI: 10.1007/s10151-008-0407-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 04/10/2008] [Indexed: 12/18/2022]
Abstract
BACKGROUND The aim of the survey was to assess the incidence of anastomotic leaks (AL) and to identify risk factors predicting incidence and gravity of AL after low anterior resection (LAR) for rectal cancer performed by colorectal surgeons of the Italian Society of Colorectal Surgery (SICCR). METHODS Information about patients with rectal cancers less than 12 cm from the anal verge who underwent LAR during 2005 was collected retrospectively. AL was classified as grade I to IV according to gravity. Fifteen clinical variables were examined by univariate and multivariate analyses. Further analysis was conducted on patients with AL to identify factors correlated with gravity. RESULTS There were 520 patients representing 64% of LAR for rectal cancer performed by SICCR members. The overall rate of AL was 15.2%. Mortality was 2.7% including 0.6% from AL. The incidence of AL was correlated with higher age (p<0.05), lower (<20 per year) centre case volume (p<0.05), obesity (p<0.05), malnutrition (p<0.01) and intraoperative contamination (p<0.05), and was lower in patients with a colonic J-pouch reservoir (p<0.05). In the multivariate analysis age, malnutrition and intraoperative contamination were independent predictors. The only predictor of severe (grade III/IV) AL was alcohol/smoking habits (p<0.05) while the absence of a diverting stoma was borderline significant (p<0.07). CONCLUSION Our retrospective survey identified several risk factors for AL. This survey was a necessary step to construct prospective interventional studies and to establish benchmark standards for outcome studies.
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Affiliation(s)
- C R Asteria
- Department of Clinical Physiopathology AOU Careggi, University of Florence, Via Morgagni 85, I-50134 Florence, Italy.
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Gibbs P, Handolias D, McLaughlin S, Chapman M, Johns J, Faragher I. Single-institution experience of adjuvant 5-fluorouracil-based chemotherapy for stage III colon cancer. Intern Med J 2008; 38:265-9. [DOI: 10.1111/j.1445-5994.2007.01520.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gagliardi AR, Wright FC, Grunfeld E, Davis D. Colorectal cancer care knowledge mapping: identifying priorities for knowledge translation research. Cancer Causes Control 2008; 19:615-30. [PMID: 18270797 DOI: 10.1007/s10552-008-9126-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Accepted: 01/22/2008] [Indexed: 01/16/2023]
Abstract
OBJECTIVE We do not know the extent and nature of knowledge translation (KT) in oncology. This study examined colorectal cancer (CRC) health services research, and engaged researchers and decision makers in prioritizing KT research gaps. METHODS MEDLINE was searched from 1996 to 2006 for CRC health services research in Canada, Australia, the United Kingdom, and United States. Studies were tabulated by indicator, type of research and country to reveal gaps. Researchers and decision makers prioritized gaps via questionnaire, then generated research questions for top-ranked gaps at a one-day workshop. RESULTS A total of 132 articles were categorized and 29 individuals attended the workshop. We lack knowledge about factors influencing rates of many indicators. Researchers and decision makers prioritized KT research on factors that could either influence the utilization of screening or enhance the quality of surgical outcomes. They acknowledged lack of research capacity and policy support as barriers, and confusion about the concept of KT. CONCLUSIONS Several opportunities were revealed for improving the quality of CRC screening and surgery. Greater coordination of, and support for KT research is required to address these gaps. Further research should evaluate different methods of achieving KT between researchers and decision makers for research planning.
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Affiliation(s)
- Anna R Gagliardi
- Department of Surgery, Faculty of Medicine, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada.
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Sjo OH, Lunde OC, Nygaard K, Sandvik L, Nesbakken A. Tumour location is a prognostic factor for survival in colonic cancer patients. Colorectal Dis 2008; 10:33-40. [PMID: 17672872 DOI: 10.1111/j.1463-1318.2007.01302.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate survival and prognostic factors in a consecutive series of colon cancer patients from a defined city population in Norway. METHOD All patients with adenocarcinoma of the colon diagnosed between 1993 and 2000 were registered prospectively. Five-year actuarial survival and 5-year relative survival rates were calculated. Cox regression analyses were used to study the effect of prognostic factors on survival. RESULTS In the study period 627 patients were admitted. Overall 5-year relative survival was 50% in females and 52% in males. Five-year relative survival in 410 (65%) patients operated with curative intent, was 74% for females and 79% for males. Tumour location in the transverse colon, splenic flexure and descending colon (OR = 1.8), emergency operation (OR = 1.7), TNM stage (OR = 1.8-2.9), blood transfusion of more than two units (OR = 1.8) and age (OR = 4.0-7.1) were independent negative prognostic factors. CONCLUSION Colon cancer located in the transverse and descending colon is associated with poor prognosis. Comparison of results from different centres is difficult due to selection and classification differences, and different methods used for calculation of survival.
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Affiliation(s)
- O H Sjo
- Department of Gastrointestinal Surgery, Aker University Hospital, Oslo, Norway.
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Visser O, Bakx R, Zoetmulder FAN, Levering CC, Meijer S, Slors JFM, van Lanschot JJB. The influence of total mesorectal excision on local recurrence and survival in rectal cancer patients: a population-based study in Greater Amsterdam. J Surg Oncol 2007; 95:447-54. [PMID: 17048237 DOI: 10.1002/jso.20713] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES To determine retrospectively in a population-based setting, the influence of the introduction of total mesorectal excision (TME) on local recurrence and survival in patients with rectal carcinoma. METHODS All rectal carcinomas diagnosed during 1988-1991 (979 patients, conventional surgery with blunt dissection of the rectum) and 1998-2000 (890 patients, TME resection) were selected from the Amsterdam Cancer Registry. For all patients who underwent a macroscopically radical resection in the absence of distant dissemination, information on the occurrence of local recurrent disease and distant metastasis was collected. RESULTS The cumulative 5-year recurrence rate decreased significantly from 20% for patients diagnosed in 1988-1991 to 11% in 1998-2000. Stage (T-category, nodal status), period of diagnosis (conventional surgery vs. TME resection), radiotherapy, and chemotherapy were independent variables of local recurrence in multivariate analysis. There was a non-significant trend for improved 5-year relative survival for all rectal carcinoma cases from 52% (95% CI 48-55) for patients diagnosed in 1988-1991 to 59% (95% CI 55-63) in 1998-2000. CONCLUSIONS A significant decrease in local recurrence and a trend for improved relative survival were observed. The broad introduction of TME and the shift towards preoperative radiotherapy are the most plausible explanations for these observations.
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Affiliation(s)
- O Visser
- Comprehensive Cancer Centre Amsterdam, Amsterdam, The Netherlands.
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Abstract
BACKGROUND There is evolving interest in auditing and credentialling the performance of surgeons. The incidence of anastomotic leakage has been proposed as a measure of performance following colorectal surgery. The aim of this study was to evaluate the incidence and risk factors associated with anastomotic leakage in patients undergoing resections of the colon and rectum. METHODS A prospective database was developed for all patients undergoing colorectal surgery. Anastomotic leakage was defined prior to the commencement of the study. A logistic regression analysis was performed to determine independent predictors of leakage. The variables analysed included age, sex, American Society of Anesthesiology (ASA) score, anatomical location, pathology, emergency surgery, type of anastomosis, a covering stoma and radiotherapy. Significance was defined as the probability of a type 1 error of < 5%. The results are presented as odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS There were 1598 patients who underwent 1639 anastomoses. Their mean age was 63 years, 34% of patients were ASA 3 or 4, and 16% of the operations were emergencies. Anastomotic leaks occurred in 2.4% (40/1639) of anastomoses. The leak rate for intraperitoneal anastomoses was 1.5% (19/1283) vs 6.6% for extraperitoneal anastomoses (21/316). Half of these leaks (20/40) were managed with re-operation or percutaneous drainage procedures. Ultra-low anterior resections were associated with the highest leak rate (8%, 18/225). A logistic regression analysis identified a covering stoma (P = 0.0001, OR 5.078, 95% CI 2.527-10.23) and diverticular disease (P = 0.037, OR 2.304, 95% CI 1.053-5.042) as independent predictors of a leak. CONCLUSIONS Within this surgical unit, the incidence of leaks from intraabdominal anastomoses was relatively low. However, leaks in patients undergoing extraperitoneal anastomoses continue to be a major cause of morbidity and mortality.
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Affiliation(s)
- C Platell
- Colorectal Surgical Unit, Fremantle Hospital, Fremantle, WA, Australia.
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Fairley TL, Cardinez CJ, Martin J, Alley L, Friedman C, Edwards B, Jamison P. Colorectal cancer in U.S. adults younger than 50 years of age, 1998-2001. Cancer 2006; 107:1153-61. [PMID: 16862554 DOI: 10.1002/cncr.22012] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) incidence rates are increasing among persons younger than 50 years of age, a population routinely not screened unless an individual has a high risk of CRC. This population-based study focuses primarily on describing the CRC burden for persons in this age group. METHODS The data used for this study were derived from the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) surveillance systems. Age-adjusted incidence rates, rate ratios, and their corresponding 95% confidence intervals were calculated. RESULTS CRC is ranked among the top 10 cancers occurring in males and females aged 20-49 years regardless of race. Persons younger than 50 years were more likely to present with less localized and more distant disease than do older adults. Among younger adults, age-adjusted incidence rates for poorly differentiated cancers were twice as high as rates for well-differentiated cancers. Incidence rates for poorly differentiated cancers were 60% higher than that for well-differentiated cancers diagnosed in older adults. Rates were significantly higher for blacks and significantly lower for Asians/Pacific Islanders when compared with that for whites for the most demographic and tumor characteristics examined. CONCLUSIONS This study confirms the findings of previous population-based studies suggesting that younger patients present with more advanced disease than do older patients. This study also identifies racial and ethnic disparities in CRC incidence in this population. These findings suggest the need for additional studies to understand the behavior and etiology of CRC in blacks.
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Affiliation(s)
- Temeika L Fairley
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Hall SE, Holman CDJ, Platell C, Sheiner H, Threlfall T, Semmens J. Colorectal cancer surgical care and survival: do private health insurance, socioeconomic and locational status make a difference? ANZ J Surg 2005; 75:929-35. [PMID: 16336380 DOI: 10.1111/j.1445-2197.2005.03583.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of the present paper was to examine patterns of surgical care and the likelihood of death within 5 years after a diagnosis of colorectal cancer, including the effects of demographic, locational and socioeconomic disadvantage and the possession of private health insurance. METHODS The Western Australian Data Linkage System was used to extract all hospital morbidity, cancer and death records for people with a diagnosis of colorectal cancer from 1982 to 2001. Demographic, hospital and private health insurance information was available for all years and measures of socioeconomic and locational disadvantage from 1991. A logistic regression model estimated the probability of receiving colorectal surgery. A Cox regression model estimated the likelihood of death from any cause within 5 years of diagnosis. RESULTS People were more likely to undergo colorectal surgery if they were younger, had less comorbidity and were married/defacto or divorced. People with a first admission to a private hospital (odds ratio (OR) 1.31, 95% confidence interval (CI): 1.16-1.48) or with private health insurance (OR 1.27, 95% CI: 1.14-1.42) were more likely to undergo surgery. Living in a rural or remote area made little difference, but a first admission to a rural hospital reduced the likelihood of surgery (OR 0.76, 95% CI: 0.66-0.87). Residency in lower socioeconomic areas also made no difference to the likelihood of having surgical treatment. The likelihood of death from any cause was lower in those who were younger, had less comorbidity, were elective admissions and underwent surgery. Residency in lower socioeconomic status and rural areas, admission to a rural hospital or a private hospital and possession of private health insurance had no effect on the likelihood of death. CONCLUSIONS The present study demonstrates that socioeconomic and locational status and access to private health care had no significant effects on surgical patterns of care in people with colorectal cancer. However, despite the higher rates of surgery in the private hospitals and among those with private health insurance, their survival was no better.
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Affiliation(s)
- Sonja E Hall
- School of Population Health, University of Western Australia, Crawley, Western Australia, Australia.
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Rabeneck L, Paszat LF, Rothwell DM, He J. Temporal trends in new diagnoses of colorectal cancer with obstruction, perforation, or emergency admission in Ontario: 1993-2001. Am J Gastroenterol 2005; 100:672-6. [PMID: 15743367 DOI: 10.1111/j.1572-0241.2005.41228.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Previous studies have shown that patients newly diagnosed with colorectal cancer requiring emergency admission to hospital or presenting with obstruction or perforation (defined here as OPE) have advanced disease. None of these studies, however, has evaluated temporal trends in these adverse outcomes, which may reflect screening failures. We evaluated temporal trends in the proportion of Ontario patients with a new diagnosis of colorectal cancer and OPE. METHODS Data were obtained from four sources: the Ontario Cancer Registry (OCR); the Canadian Institute for Health Information (CIHI) database, which contains diagnostic information on all patients discharged from hospitals; the Ontario Health Insurance Plan (OHIP) database, which records all physician claims in Ontario; and the Registered Persons Database, which contains demographic information on all Ontario residents covered under OHIP. We calculated the proportion of patients (>/=20 yr) with a new diagnosis of colorectal cancer recorded in CIHI who presented with OPE between 1993 and 2001. These patients were assigned to one of three cohort years: 1993-1995, 1996-1998, or 1999-2001. Those who received chemotherapy, radiotherapy, or palliative care before their first admission to hospital were excluded. We repeated the analysis using the number of OPE patients identified from CIHI in the numerator, and the number of patients (>/=20 yr) with a new diagnosis of colorectal cancer recorded in the OCR in the denominator. Adjusted risk of OPE was calculated using a logistic regression model. RESULTS Between 1993 and 2001, 59,670 patients with a new diagnosis of colorectal cancer were recorded in the CIHI database and 54,103 in the OCR. The proportion of these patients with OPE recorded in the CIHI decreased significantly over time: 23.8% (95% CI = 23.2-24.4%) during 1993-1995, 19.4% (95% CI = 18.8-20.0%) during 1996-1998, and 18.1% (95% CI 17.6-18.6%) during 1999-2001 (a 24% relative decrease over time). The relative decrease calculated from OCR data was similar. The adjusted relative decrease in the proportion of patients with OPE during 1993-2001 was 31%. CONCLUSIONS Much greater emphasis on screening is needed since approximately 20% of patients with a new diagnosis of colorectal cancer in 1999-2001 presented with OPE.
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Affiliation(s)
- Linda Rabeneck
- Institute for Clinical Evaluative Sciences, Sunnybrook and Women's College Health Sciences Centre, Toronto, Canada
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Boutard P, Platell C, Threlfall T. Model for collecting colorectal cancer staging information in Western Australia. ANZ J Surg 2004; 74:895-9. [PMID: 15456441 DOI: 10.1111/j.1445-1433.2004.03199.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is recognition that to improve the management of patients with cancer we need to monitor outcomes, especially survival outcomes based on tumour stage. Unfortunately, there are few centres in Australia that can provide stage stratified survival information, despite the large investments that have been made in data collection. The aim of this study was to collect staging information for all colorectal cancers diagnosed in Western Australia over a 12-month period. This information could then serve as a basis for more meaningful analysis. METHODS A project officer was appointed to coordinate a programme through the Western Australian Cancer Registry. A consensus was reached among pathologists on the standardized reporting of colorectal cancers to the registry. Clinicians were asked to provide, on pathology request forms, information on tumour location, the presence of metastatic disease (on X-ray or at laparotomy), and type of surgery. Use was also made of existing hospital and unit based databases to acquire and crosscheck information. RESULTS Over a 12-month study period, 1008 patients with colorectal cancers were notified to the Cancer Registry. Their mean age was 69.1 years (range 23-100 years), 56% were men and 44% women. The rectum was the most common site for disease location (32.5%). At cessation of the project, 743 patients (74%) were fully staged, with a further 221 patients (22%) having completed data on tumour depth of penetration and nodal status, but insufficient information on the presence of metastases. The stage distributions were: stage I - 20.5%; stage II - 29.9%; stage III - 26.2%; stage IV - 23.4%. CONCLUSIONS It is feasible to collect staging information on colorectal cancers notified to a population based cancer registry. This information will be invaluable for stage stratified survival analysis and research.
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Affiliation(s)
- Padabphet Boutard
- The Western Australian Cancer Registry at the Health Department of Western Australia, Western Australia, Australia
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Edwards JT, Mendelson RM, Fritschi L, Foster NM, Wood C, Murray D, Forbes GM. Colorectal neoplasia screening with CT colonography in average-risk asymptomatic subjects: community-based study. Radiology 2003; 230:459-64. [PMID: 14688402 DOI: 10.1148/radiol.2302021422] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate computed tomographic (CT) colonography as a screening tool for average-risk asymptomatic subjects with regard to participation, acceptability, and safety. MATERIALS AND METHODS CT colonography for colorectal neoplasia screening was offered to 2,000 subjects aged 50-54 and 65-69 years. Only asymptomatic subjects at average risk of colorectal neoplasia were enrolled. Participants underwent CT colonography followed by colonoscopy if CT colonography findings showed any polyps. Acceptability was measured with a 100-point (0, most favorable; 100, least favorable) visual analogue scale (VAS). Chi2 statistic was used to compare participation rates among subgroups. Safety of CT colonography was evaluated by recording all important adverse events. RESULTS A total of 1,452 subjects were eligible for screening. The adjusted participation rate was 28.4%. Participation was higher in younger subjects and in those from a high socioeconomic region. Major reasons for nonparticipation were insufficient time and perceived good health. Median VAS scores for pain, general satisfaction, embarrassment, and willingness to repeat screening were 13, 6, 8, and 5, respectively. Most subjects found CT colonography better than (60%) or same as (32%) expected. Ninety-three (27.4%) of 340 subjects were referred for colonoscopy, with polyps found in 67 (positive predictive value, 0.73). By adopting criteria that a positive finding at CT colonography is that of a single polyp larger than 5 mm or multiple polyps larger than 2 mm, 14% of CT examinations would have led to colonoscopy; 5.7% of CT findings were false-positive, with no significant impairment in large polyp detection. There were no important adverse events related to CT colonography, although four subjects had syncope or presyncope related to bowel preparation. CONCLUSION Community-based colorectal neoplasia screening with CT colonography was accompanied by a participation rate that compares favorably with that of similar screening programs. CT colonography was highly acceptable to participants.
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Affiliation(s)
- John T Edwards
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Box X2213 GPO Perth, Western Australia 6000.
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Abstract
The study described in this article addressed the phenomena of living with a diagnosis of colorectal cancer. Rationale for undertaking the research was that a need had been identified to describe the experience of living with a diagnosis of colorectal cancer and what this means to an individual. To explore the lived experience of colorectal cancer, a phenomenological study was undertaken based on Heidegger's philosophy as presented in his seminal work 'Being and Time'. Seven patients diagnosed with colorectal cancer were interviewed over a time-span of 13 months. Patients participating in the study were recruited from three Swiss hospitals. Data were analysed by following Colaizzi's eight-step process as cited in Haase (1987, p 66-67). Analysis identified one main category: 'The Omnipresence of Cancer' and two sub-categories: 'Towards Authentic Dasein' (Towards Authentic Being) and 'Mapping out the Future'. The research demonstrated that having received a diagnosis of cancer means an individual is faced with the potential of lifelong illness and death, feels stigmatised by the diagnosis and is classified as belonging to an illness group. Individuals who have been diagnosed with colorectal cancer need to talk with health-care professionals about their experiences and concerns. It is important that in-depth discussions occur between patients and health-care professionals so that the patient's questions and uncertainties may be addressed.
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Laurvick CL, Semmens JB, Leung YC, Holman CDJ. Ovarian cancer in Western Australia (1982-1998): trends in surgical intervention and relative survival. Gynecol Oncol 2003; 88:141-8. [PMID: 12586593 DOI: 10.1016/s0090-8258(02)00095-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We aimed to review the utilisation and trends in surgical procedures for the primary management of ovarian cancer and the survival outcomes of patients surgically treated in Western Australia. METHODS The population-based Western Australia Data Linkage System was used to link hospital morbidity and mortality data for all women diagnosed with malignant primary ovarian cancer in the State Cancer Registry in the period 1982-1998. Poisson regression was used to analyse trends in surgical procedure rates. Logistic regression examined the likelihood of having a surgical procedure in the periods 1988-1993 and 1994-1998 compared with 1982-1987. Relative survival was used to adjust survival estimates for other causes of death occurring in the general female population. RESULTS There were 1,126 women who underwent a primary surgical procedure for ovarian cancer in Western Australia in the period 1982-1998. Women were more likely to undergo surgery in 1994-1998 (87.8%) compared with 1988-1993 (76.8%), but there was no difference when compared to 1982-1987 (89.2%) (P = 0.62). The likelihood of using specific surgical procedures to treat ovarian cancer increased for all but total abdominal hysterectomy. Bilateral salpingo-oophorectomy was 3.7 times more likely to be performed and omentectomy 5 times more likely to be performed in 1994-1998 compared with 1982-1987. The median length of hospital stay decreased from 15 to 12 days and emergency admissions decreased from 26.5 to 15.4% over the three time periods. Thirty-two percent of women were readmitted within 30 days of separation from their primary surgery, 23% of which were for the same-day treatment with either chemotherapy or radiotherapy. A 15% increase in relative survival was observed between the periods 1982-1997 (38.8%) and 1994-1998 (53.5%).Conclusion. CONCLUSION Surgery remains a cornerstone in the primary management of ovarian cancer. There have been dramatic shifts in surgical practice in Western Australia, with more women undergoing certain surgical procedures today than they were 20 years ago. Coupling the increasing surgical trends are improved outcomes. Fewer women are presenting as an emergency, the length of hospital stay has been reduced, and survival outcomes have shown a significant improvement.
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Affiliation(s)
- Crystal L Laurvick
- Centre for Health Services Research, School of Population Health, The University of Western Australia, Nedlands-, Western Australia, Australia.
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Mitry E, Bouvier AM, Esteve J, Faivre J. Benefit of operative mortality reduction on colorectal cancer survival. Br J Surg 2002; 89:1557-62. [PMID: 12445066 DOI: 10.1046/j.1365-2168.2002.02276.x] [Citation(s) in RCA: 167] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was to determine trends in operative mortality after colorectal cancer surgery over a 20-year period in a well defined population, and consequences on overall survival. METHODS Some 4745 new cases of colorectal adenocarcinoma were registered between 1976 and 1995 in a French region containing 500 000 people. Among these, 84.3 per cent were operated on, of whom 78.1 per cent were resected. RESULTS The overall operative mortality rate decreased from 17.7 to 8.1 per cent between 1976-1979 and 1992-1995. Corresponding rates after curative surgery were 12.6 and 6.2 per cent respectively. Period of diagnosis, age and subsite were factors independently associated with operative mortality. Applying the operative mortality rates for the interval 1976-1979 to the 1992-1995 cohort, the expected 5-year survival rate after curative surgery would have been 40.0 per cent, compared with an observed rate of 51.0 per cent. This corresponds to a 27.5 per cent improvement in 5-year overall survival. Applying this result to the French population as a whole, it was estimated that almost 3000 deaths are avoided each year in France as a result of the reduction in operative mortality. CONCLUSION Operative mortality decreased dramatically over the 20 years of the study. It was associated with a significant improvement in survival after surgery for cure.
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Affiliation(s)
- E Mitry
- Registre des Cancers Digestifs, Faculté de Médecine, Dijon and Service de Biostatistique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.
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Killingback M, Barron P, Dent O. Elective resection and anastomosis for colorectal cancer: a prospective audit of mortality and morbidity 1976-1998. ANZ J Surg 2002; 72:689-98. [PMID: 12534376 DOI: 10.1046/j.1445-2197.2002.02524.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The purpose of this paper is to audit the morbidity and mortality for colorectal cancer after open elective resection and anastomosis by a single colorectal surgeon (MK), with reference to any differences between intraperitoneal (IPA) and extra-peritoneal anastomoses (EPA). METHODS The prospective documentation of postoperative complications was compiled by the surgeon, charge nurses and a research assistant (PB). The operations were performed in three hospitals between 1976 and 1998. RESULTS Some 1392 consecutive patients were treated electively by 1418 resections with anastomosis. There were 23 postoperative deaths (1.6%). Significant adverse events, which were potentially avoidable, occurred in 10 (43.5%) of the patients who died. The morbidity rate was 41.6%. Clinical anastomotic leaks occurred more frequently in EPA (27/581, 4.7%) than in IPA (2/827, 0.2%; P < 0.0001). Anastomotic leak caused the death of two patients (0.14%).Routine prophylactic anticoagulation did not decrease the incidence of pulmonary embolism. Significant thrombophlebitis at the intravenous cannula site occurred in 54 patients (3.8%), wound infection in 29 (2.1%), and postural peripheral nerve injury in the upper limbs occurred in 11 patients (0.8%). Thirty-eight patients (2.7%) were returned to the operating theatre for 42 unscheduled operations. CONCLUSION Mortality associated with elective resection of colorectal cancer with anastomosis is principally related to age, cardio-vascular disease and avoidable adverse events. A wide range of complications may follow this type of surgery, especially after extra peritoneal operations. A classification of anastomotic leaks is suggested to assist in comparisons of this complication which remains a significant concern following extra peritoneal anastomoses.
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Abstract
OBJECTIVE: To perform a prospective audit of outcomes and survival of all patients presenting to a colorectal service with colorectal cancer, and to compare these results with an historical control group. PATIENTS AND METHODS: At a community based teaching hospital, a prospective audit of outcomes and survival of patients with colorectal cancer was compared with a historical control. The study included all patients referred to a colorectal service with colorectal cancer from 1996 to 2000 (5-year period). The control group was a retrospective review of patients presenting to the same hospital with colorectal cancer from 1989 to 1994 (6-year period). A Kaplan-Meier survival analysis compared the overall survival (all-cause mortality) between the two groups. RESULTS: When comparing the study periods 1989-95 (n = 477) to 1996-2000 (n = 323), there has been a significant reduction in postoperative stay (16.2 vs 8.0 days, P < 0.05), and a reduction in postoperative mortality (4.5%vs 2.7%, n.s.). There was a significant increase in the overall 2 years survival for patients with colorectal cancer (62% to 71%, P < 0.01). There was also a significant increase in the overall 2 years survival of patients with rectal cancer (66% to 74%, P < 0.01), patients with ACPS C colon cancers (64% to 83%, P < 0.05), and ACPS C rectal cancers (74% to 85%, P < 0.01). CONCLUSIONS: There have been significant gains in the survival of patients presenting to a community based teaching hospital with colorectal cancer. These improvements have been most notable in patients with nodal metastases at the time of diagnosis.
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Affiliation(s)
- C. Platell
- Department of Surgery, University of Western Australia, Fremantle Hospital, Fremantle, Australia
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Goodney PP, Siewers AE, Stukel TA, Lucas FL, Wennberg DE, Birkmeyer JD. Is surgery getting safer? National trends in operative mortality. J Am Coll Surg 2002; 195:219-27. [PMID: 12168969 DOI: 10.1016/s1072-7515(02)01228-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although mortality rates for some cardiovascular procedures seem to have declined, it is unclear whether other high-risk procedures are becoming safer over time. STUDY DESIGN We examined national trends between 1994 and 1999 in operative mortality for 14 high-risk cardiovascular and cancer procedures in the national population of Medicare beneficiaries over age 65. Secular trends were examined using logistic regression adjusting for age, gender, race, socioeconomic status, admission acuity, comorbidities, and hospital volume. RESULTS Observed mortality rates varied widely across the 14 procedures, from 2% (carotid endarterectomy) to 16% (esophagectomy). Over the 6-year study period, average patient age increased for all procedures, and patients were more likely to undergo operation at high-volume hospitals for some procedures (pancreatic resection, esophagectomy, cystectomy, and pneumonectomy). After accounting for these changes, operative mortality declined significantly for three cardiovascular procedures, as evidenced by adjusted odds ratios (OR) for the 6-year effect on operative mortality (coronary artery bypass graft OR = 0.85, 95% confidence interval [CI] 0.81 to 0.88; carotid endarterectomy OR = 0.86,95% CI 0.80 to 0.93; mitral valve replacement OR = 0.89, 95% CI 0.81 to 0.97). In contrast, operative mortality did not decline for any of the cancer procedures. In fact, adjusted mortality increased for colectomy for colon cancer (OR= 1.13, 95% CI 1.07 to 1.19). CONCLUSIONS Although risks of some cardiovascular procedures are declining over time, there is no evidence that other types of high-risk surgery are becoming safer. These findings suggest the need for systematic efforts to monitor and improve surgical performance.
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Affiliation(s)
- Philip P Goodney
- VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT 05009, USA
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Wan J, Zhang ZQ, Zhu C, Wang MW, Zhao DH, Fu YH, Zhang JP, Wang YH, Wu BY. Colonoscopic screening and follow-up for colorectal cancer in the elderly. World J Gastroenterol 2002; 8:267-9. [PMID: 11925605 PMCID: PMC4658364 DOI: 10.3748/wjg.v8.i2.267] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To improve the prevention and treatment of senile patients with colorectal cancer by evaluating the importance of colonoscopy in clinical screening and follow-up.
METHODS: Clinical screening of colonoscopy was performed for 2196 patients aged 60-90 years old according to the protocol, and 1740 of them (79.2%) were followed-up.
RESULTS: Colorectal cancer was found in 52 patients, and the detectable rate was 2.4%. Among them, 19 were diagnosed as early colorectal cancer, accounting for 36.5% of the detected colorectal cancer. Among the followed-up patients, early colorectal cancer was found in 9, accounting for 45.0% of the detected colorectal cancer. The resectable rate and 5 years survival rate of colorectal cancer were 97.7% and 80.9% respectively. The incidence of complication was 0.05%, and the successful rate of cecum intubation was 98.9%.
CONCLUSION: Colonoscopic screening and follow-up of the elderly for colorectal cancer and pre-cancerous lesion (adenomatoid polyp) can increase the detectable rate of early colorectal cancer and improve its prevention and treatment.
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Affiliation(s)
- Jun Wan
- Department of Gastroenterology, General Hospital of the Chinese PLA, Beijing 100853, China.
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Farmer KC, Penfold C, Millar JL, Zalcberg J, McLeish JA, Thomas RJS, Lade S, Thursfield VJ, Giles GG. Rectal cancer in Victoria in 1994: patterns of reported management. ANZ J Surg 2002; 72:265-70. [PMID: 11982512 DOI: 10.1046/j.1445-2197.2002.02371.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND A retrospective survey of medical practitioners was conducted to describe the management of patients newly diagnosed with rectal cancer in 1994, prior to the publication of best practice guidelines. METHODS A sample of 908 patients with rectal cancer diagnosed between 1 January and 31 December 1994 was identified from the Victorian Cancer Registry. Questionnaires were then sent to the treating doctor(s) for completion. The topics covered by the questionnaires included: reported management by method of diagnosis; staging investigations; and treatment by surgery, chemotherapy and radiotherapy. RESULTS Seven hundred and twenty-six (80%) of 908 eligible patients were surveyed. Surgery was the primary treatment in 681 (93.8%) with curative intent in 483 (70.9%) of these cases. One- third (163; 33.7%) of curative cases were pathologically staged as Dukes' C. Almost all patients (96%) were symptomatic, and three-quarters were referred by general practitioners to 166 surgeons. One-third (221; 32.5%) underwent liver computed tomography or ultrasound, and only three cases had transrectal ultrasound. Restorative anterior resection was the most common surgical procedure (431; 63.3%) with 160 (23.5%) and 34 (5.0%) patients being managed with abdominoperineal resections and local excision, respectively. Chemotherapy and radiotherapy were administered as part of the initial management to 216 (31.7%) and 171 (25.1%) patients, respectively. In five of the 171 cases, radiotherapy was given preoperatively. CONCLUSIONS There was considerable variation in preoperative assessment. Staging was less complete than expected by today's standards. The diversity of surgical techniques observed may reflect both the lack of clinical trials and disparity in surgical training and experience. Referral to stomal therapists, and medical and radiation oncologists was lower than would now be expected, as was the use and timing of adjuvant therapies. These findings will be useful as a baseline for comparison with subsequent surveys conducted since the introduction of evidence-based guidelines.
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Affiliation(s)
- K Chip Farmer
- Victorian Cancer Registry, Anti-Cancer Council of Victoria, Carlton, Australia.
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Abstract
BACKGROUND The assumption that colonoscopy is highly accurate for detecting colorectal cancer was tested by identifying cancer subsequent to colonoscopy in 2 cohorts of patients in which colonoscopy was reported as normal. METHODS A multicenter endoscopy database was used to identify all reportedly normal colonoscopies. One cohort was assessed 5 years after colonoscopy with the use of a population-based health services-linked database to link patient morbidity, cancer, and mortality data. The second cohort was assessed by identifying patients who had cancer on repeat colonoscopy. RESULTS Of 1047 patients with normal colonoscopies followed for 5 years or until death if earlier, 5 cancers (0.5%) were detected. This rate was not significantly different from that predicted by Australian statistics (risk = 1.0%, p > 0.1), but significantly lower compared with that for all patients presenting for colonoscopy during the study period (risk = 5.2%, p < 0.001). In another cohort of 8486 patients with reportedly normal colonoscopies, 496 patients underwent repeat colonoscopies during an average follow-up of 3.1 years; cancer was diagnosed at the subsequent procedure in 3 patients (0.6%). CONCLUSIONS The high accuracy of colonoscopy is demonstrated by the low risk of harboring an advanced neoplastic lesion after a normal examination.
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Affiliation(s)
- Hooi C Ee
- Department of Gastroenterology, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia
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Hodgson DC, Fuchs CS, Ayanian JZ. Impact of patient and provider characteristics on the treatment and outcomes of colorectal cancer. J Natl Cancer Inst 2001; 93:501-15. [PMID: 11287444 DOI: 10.1093/jnci/93.7.501] [Citation(s) in RCA: 148] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
While the management and prognosis of colorectal cancer are largely dependent on clinical features such as tumor stage, there is considerable variation in treatment and outcome not explained by traditional prognostic factors. To guide efforts by researchers and health-care providers to improve quality of care, we review studies of variation in treatment and outcome by patient and provider characteristics. Surgeon expertise and case volume are associated with improved tumor control, although surgeon and hospital factors are not associated consistently with perioperative mortality or long-term survival. Some studies indicate that patients are less likely to undergo permanent colostomy if they are treated by high-volume surgeons and hospitals. Differences in treatment and outcome of patients managed by health maintenance organizations or fee-for-service providers have not generally been found. Older patients are less likely to receive adjuvant therapy after surgery, even after adjustment for comorbid illness. In the United States, black patients with colorectal cancer receive less aggressive therapy and are more likely to die of this disease than white patients, but cancer-specific survival differences are reduced or eliminated when black patients receive comparable treatment. Patients of low socioeconomic status (SES) have worse survival than those of higher SES, although the reasons for this discrepancy are not well understood. Variations in treatment may arise from inadequate physician knowledge of practice guidelines, treatment decisions based on unmeasured clinical factors, or patient preferences. To improve quality of care for colorectal cancer, a better understanding of mechanisms underlying associations between patient and provider characteristics and outcomes is required.
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Affiliation(s)
- D C Hodgson
- D. C. Hodgson, Department of Radiation Oncology, Princess Margaret Hospital and Institute for Clinical Evaluative Sciences, University of Toronto, ON, Canada
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