TY - JOUR
T1 - Adequacy of the national quality forum's colon cancer adjuvant chemotherapy quality metric
T2 - Is 4 months soon enough?
AU - Massarweh, Nader N.
AU - Haynes, Alex B.
AU - Chiang, Yi Ju
AU - Chang, George J.
AU - You, Y. Nancy
AU - Feig, Barry W.
AU - Cormier, Janice N.
N1 - Publisher Copyright:
© 2015 Wolters Kluwer Health, Inc.
PY - 2015/8/30
Y1 - 2015/8/30
N2 - Objective: To ascertain whether the National Quality Forum-endorsed time interval for adjuvant chemotherapy (AC) initiation optimizes patient outcome. Background: Delayed AC initiation for stage III colon cancer is associated with worse survival and the focus of a National Quality Forum quality metric (<4 months among patients aged <80 years). Methods: Observational cohort study of patients with stage III colon cancer younger than 80 years within the National Cancer Data Base (2003-2010). The primary outcome was 5-year overall survival evaluated using multivariate Cox proportional hazards regression. Aggregate survival estimates for historical surgery-only controls from pooled National Surgical Adjuvant Breast and Bowel Project trial data were also used. Results: Among 51,331 patients (60.8 ± 11.6 years, 50.2% males, and 77.3% white), 76.3% received standard AC (≤2 months) and 21.6% delayed (>2 and <4 months) AC. Earlier AC was associated with better 5-year overall survival [standard AC, 69.8%; delayed AC, 62.0%; late AC (4-6 months), 51.4%; log-rank, P < 0.001]. The survival rate after late AC was similar to surgery alone (51.1%; Wilcoxon rank sum, P = 0.10). Compared with late AC, standard AC (hazard ratio, 0.62; 95% confidence interval, 0.54-0.72) and delayed AC (hazard ratio, 0.77; 95% confidence interval, 0.66-0.89) significantly decreased risk of death. Risk of death was also lower for standard AC compared to delayed AC (hazard ratio, 0.81; 95% confidence interval, 0.77-0.86). Conclusions: One in 5 patients with stage III colon cancer initiates AC within the National Quality Forum-endorsed interval, but does not derive the full benefit. These data support strengthening current quality improvement initiatives and colon cancer treatment guidelines to encourage AC initiation within 2 months of resection when possible, but not beyond 4 months.
AB - Objective: To ascertain whether the National Quality Forum-endorsed time interval for adjuvant chemotherapy (AC) initiation optimizes patient outcome. Background: Delayed AC initiation for stage III colon cancer is associated with worse survival and the focus of a National Quality Forum quality metric (<4 months among patients aged <80 years). Methods: Observational cohort study of patients with stage III colon cancer younger than 80 years within the National Cancer Data Base (2003-2010). The primary outcome was 5-year overall survival evaluated using multivariate Cox proportional hazards regression. Aggregate survival estimates for historical surgery-only controls from pooled National Surgical Adjuvant Breast and Bowel Project trial data were also used. Results: Among 51,331 patients (60.8 ± 11.6 years, 50.2% males, and 77.3% white), 76.3% received standard AC (≤2 months) and 21.6% delayed (>2 and <4 months) AC. Earlier AC was associated with better 5-year overall survival [standard AC, 69.8%; delayed AC, 62.0%; late AC (4-6 months), 51.4%; log-rank, P < 0.001]. The survival rate after late AC was similar to surgery alone (51.1%; Wilcoxon rank sum, P = 0.10). Compared with late AC, standard AC (hazard ratio, 0.62; 95% confidence interval, 0.54-0.72) and delayed AC (hazard ratio, 0.77; 95% confidence interval, 0.66-0.89) significantly decreased risk of death. Risk of death was also lower for standard AC compared to delayed AC (hazard ratio, 0.81; 95% confidence interval, 0.77-0.86). Conclusions: One in 5 patients with stage III colon cancer initiates AC within the National Quality Forum-endorsed interval, but does not derive the full benefit. These data support strengthening current quality improvement initiatives and colon cancer treatment guidelines to encourage AC initiation within 2 months of resection when possible, but not beyond 4 months.
KW - National Quality Forum
KW - adjuvant chemotherapy
KW - colon cancer
KW - quality metric
KW - quality of care
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U2 - 10.1097/SLA.0000000000000859
DO - 10.1097/SLA.0000000000000859
M3 - Article
C2 - 25185467
AN - SCOPUS:84938252164
SN - 0003-4932
VL - 262
SP - 312
EP - 320
JO - Annals of surgery
JF - Annals of surgery
IS - 2
ER -