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O'Grady MA , Slater E , Sigurdson ER , Meropol NJ , Weinstein A , Lusch CJ , Sein E , Keeley P , Miller B , Engstrom PF , Cohen SJ
Assessing Compliance with National Comprehensive Cancer Network Guidelines for Elderly Patients with Stage III Colon Cancer: The Fox Chase Cancer Center Partners' Initiative
Clinical Colorectal Cancer. 2011 Jun;10(2) :113-116
PMID: ISI:000291297000007    PMCID: PMC3388796   
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Background: Fox Chase Cancer Center Partners (FCCCP) performs an annual quality review of affiliate practices based on National Comprehensive Cancer Network (NCCN) guidelines. Given recent treatment advances, we initiated this medical record review in elderly patients with stage Ill colon cancer to measure compliance with these guidelines. Methods: Medical records of 124 patients age 65 diagnosed with stage Ill colon cancer between 2003 and 2006 were reviewed. Metrics were developed and based on NCCN guidelines for workup and staging, treatment, and gerontology. Documentation was reviewed via paper (13 sites) and electronic record (2 sites). Results: High compliance with staging and workup guidelines was noted with chest imaging (100%), stage (98%), computed tomography (CT) of the abdomen/pelvis (93%), pathology (91%), and carcinoembryonic antigen (CEA; 91%). Activities of daily living were documented commonly (83%) but colonoscopy less (75%). Age and life expectancy were discussed with the patient in only 49%. Nearly all patients (123 of 124 patients) received adjuvant chemotherapy, with 76 patients (61%) receiving oxaliplatin. Common regimens were FOLFOX (oxaliplatin plus infusional/bolus 5-fluorouracil and folinic acid) 54%, 5-fluorouracil/leucovorin (5-FU/LV; 19%), and capecitabine (12%). Reasons for excluding oxaliplatin were comorbidity (68%), age (19%), and not specified (13%). Three-quarters of the patients had 12 lymph nodes sampled and 56% identified the radial margin. Nearly all patients (115 = 93%) received surveillance with history and physical and CEA. Surveillance CT was performed in 78% of the patients. Conclusions: A quality review of community oncology practices can assess implementation of treatment advances. Guideline compliance for elderly patients with stage Ill colon cancer is generally high. Forty percent did not receive oxaliplatin and documentation of life expectancy was infrequent. Further study of oncologist decision making for elderly colon cancer patients is warranted.
O'Grady, Margaret A. Slater, Elyse Sigurdson, Elin R. Meropol, Neal J. Weinstein, Alan Lusch, Charles J. Sein, Elaine Keeley, Patricia Miller, Bonnie Engstrom, Paul F. Cohen, Steven J. NIH from National Cancer Institute [CA006927] Research support: This work was supported by an NIH core grant #CA006927 from the National Cancer Institute. 24 Cig media group, lp; 3500 maple avenue, ste 750, dallas, tx 75219-3931 usa 773hg