Quality of Nonmetastatic Colorectal Cancer Care in the Department of Veterans Affairs

The Veterans Affairs (VA) healthcare system treats approximately 3% of patients with cancer in the United States each year. We measured the quality of nonmetastatic colorectal cancer (CRC) care in VA as indicated by concordance with National Comprehensive Cancer Network practice guidelines (six indi...

Full description

Saved in:

Bibliographic Details
Published in:	Journal of clinical oncology Vol. 28; no. 19; pp. 3176 - 3181
Main Authors:	JACKSON, George L, MELTON, L. Douglas, PROVENZALE, Dawn, ABBOTT, David H, ZULLIG, Leah L, ORDIN, Diana L, GRAMBOW, Steven C, HAMILTON, Natia S, YOUSUF ZAFAR, S, GELLAD, Ziad F, KELLEY, Michael J
Format:	Journal Article
Language:	English
Published:	Alexandria, VA American Society of Clinical Oncology 01-07-2010
Subjects:	Adult Aged Aged, 80 and over Biological and medical sciences Colorectal Neoplasms - pathology Colorectal Neoplasms - therapy Female Gastroenterology. Liver. Pancreas. Abdomen Hospitals, Veterans - standards Hospitals, Veterans - statistics & numerical data Humans Male Medical sciences Middle Aged Neoplasm Staging Original Reports Quality Assurance, Health Care Retrospective Studies Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Tumors United States United States Department of Veterans Affairs Veterans - statistics & numerical data United States Colonic disease Rectal disease Cancerology Quality Colorectal cancer Digestive diseases Intestinal disease Malignant tumor Veteran Care Cancer
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	The Veterans Affairs (VA) healthcare system treats approximately 3% of patients with cancer in the United States each year. We measured the quality of nonmetastatic colorectal cancer (CRC) care in VA as indicated by concordance with National Comprehensive Cancer Network practice guidelines (six indicators) and timeliness of care (three indicators). A retrospective medical record abstraction was done for 2,492 patients with incident stages I to III CRC diagnosed between October 1, 2003, and March 31, 2006, who underwent definitive CRC surgery. Patients were treated at one or more of 128 VA medical centers. The proportion of patients receiving guideline-concordant care and time intervals between care processes were calculated. More than 80% of patients had preoperative carcinoembryonic antigen determination (ie, stages II to III disease) and documented clear surgical margins (ie, stages II to III disease). Between 72% and 80% of patients had appropriate referral to a medical oncologist (ie, stages II to III disease), preoperative computed tomography scan of the abdomen and pelvis (ie, stages II to III disease), and adjuvant fluorouracil-based chemotherapy (ie, stage III disease). Less than half of patients with stages I to III CRC (43.5%) had a follow-up colonoscopy 7 to 18 months after surgery. The mean number of days between major treatment events included the following: 26.6 days (standard deviation [SD], 38.2; median, 20 days) between diagnosis and initiation of treatment (in stages II to III disease); 64.8 [corrected] days (SD, 54.9; median, 50 days) between definitive surgery and start of adjuvant chemotherapy (in stages II to III disease); and 444.2 [corrected] days (SD, 182.1; median, 393 days) between definitive surgery and follow-up colonoscopies (in stages I to III disease). Although there is opportunity for improvement in the area of cancer surveillance, the VA performs well in meeting established guidelines for diagnosis and treatment of CRC.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0732-183X 1527-7755
DOI:	10.1200/JCO.2009.26.7948