Presented at the NAACCR Annual Conference Quebec City June 22, 2010

 Cancer Program Practice Profile Reports  Developed by the Commission on Cancer  Web based comparative reports for COC approved facilities to assess local adherence to standards of care  Designed to implement concepts of best practices that will diminish disparities in cancer care across COC approved programs

 Breast cancer – Radiation therapy is administered within 1 year to women < age 70 who receive BCC  Breast cancer – Combination chemo is received within 4 mos. by women who are  < age 70  T1cN0M0 or Stage II or Stage III  Hormone receptor negative

 Breast cancer – Hormone therapy is received within 1 year by women who are  T1cN0M0 or Stage II or Stage III  Hormone receptor positive  Colon cancer – At least 12 regional lymph nodes are removed & examined for resected colon cancers

 Colon cancer – Adjuvant chemo is received within 4 mos. by patients who are  < age 80  Stage III (lymph node positive)  Have surgical resection  Rectal cancer – Radiation therapy is administered within 6 mos. to patients  < age 80  T4N0M0 or Stage III  Have surgical resection

 Report requested by KY hospitals  To identify all eligible patients for each CP 3 R measure and  To calculate percentage of concordant vs. non-concordant cases for the hospital

 Age between  Seq. number = 00 or 01  Site code = C18.0 or C18.2-C18.9  Behavior code = 3  Diagnosis date between 1/1/2007 and 12/31/2007  Histology = epithelial tumors (8000, 8001, …) (List provided by COC)

 pTNM Stage Group = III, IIIA, IIIB, or IIIC  Surgery at the Primary Site =  Regional Nodes Positive = 1-90, 95, or 97  Patient alive for at least 120 days after surgery

CP3R colon cases eligible for Chemo ANY MEDICAL CENTER Diagnosis Dates 01/01/2007 to 12/31/2007 ACOS Pat AccNoDxDateChemoDate Days to TxChemo PTNM Stage Group /4/20079/24/ Chemotherapy, single agent /8/20076/25/ Chemotherapy, multiple agents3A /27/200700/00/ None, chemotherapy was not part of the 1st therapy /20/20077/27/ Chemotherapy, single agent3B /11/20077/16/ Chemotherapy, multiple agents3B /21/200799/99/ Chemo recommended; unkn. If given3C /8/20077/17/ Chemotherapy, multiple agents /16/20072/19/ Chemotherapy, multiple agents3C /20/20076/11/ Chemotherapy, single agent3C /17/20076/16/ Chemotherapy, multiple agents3

 Can assess concordance in KY with national standards of care  Can determine ‘concordant’ vs. ‘non- concordant’ groups and then examine differences in age, race, area of residence, etc. in a population

 Modifications needed for CCR query  Delete class of case condition  Add ‘State at Diagnosis’ = KY  Use Stage Group criteria based on derived Collaborative Stage instead of AJCC Stage variables

 Initial query: 243 eligible cases  Compared Derived Stage Group to pTNM Stage Group  3 cases were pTNM Stage IV (metastatic); thus deleted  Final KY 2007 Stage III Colon cases (eligible per CP 3 R criteria) was 240.

 No chemotherapy  None given31  Recommended, unk. if given14  Unknown if rec. or given25  Total ‘non-concordant’7029.2%  Chemotherapy considered or given  Chemo given161  Chemo contraindicated1  Chemo refused8  Total ‘concordant’ %

 Text documentation was reviewed on all cases where chemo was refused; all were verified.  All cases where chemo was not reported to the CCR were followed back, using  Calls to hospital registrars  Calls, letters, & electronic access to physician offices  Calls, letters, & electronic access to OP facilities  On site visits  Calls and letters to out of state CCR contacts, registrars and physicians

2007 Stg III Colon cases: Chemotherapy status Orig # cases %Final # cases % No chemo given314 Chemo recommended, unknown if given141 Unknown if chemo given253 TOTAL - No chemo received Chemo, NOS3859 Chemo, single agent2731 Chemo, multiple agents96113 Chemo contraindicated17 Chemo refused822 TOTAL - Chemo received or considered

 9 cases where chemo was found to be given, no date for chemo could be found  7 cases had chemotherapy received more than 120 days beyond diagnosis date  Of these, 4 patients had various co-morbidities that delayed their chemotherapy start date, even though it had been recommended within the time frame.  2 cases that had chemotherapy more than 250 days after diagnosis were reviewed and recoded; the chemo was determined to be subsequent treatment.

2007 Stg III Colon cases: Chemotherapy status Final # cases % Chemo within 120 days187 Chemo contraindicated7 Chemo refused22 TOTAL - Chemo concordant216*93.5 Chemo received after 120 days7 No chemo given4 Chemo recommended, unknown if given1 Unknown if chemo given3 TOTAL - Non-concordant156.5 * 9 cases with chemo excluded because trt date unknown

 More information on chemotherapy given, refused, or contraindicated was found on 62 patients  33 were reported to KCR by COC hospitals  29 were reported by non-COC facilities  It took approximately 70 hours to follow back on 70 cases.

In 2007, of Kentuckians with Stage III colon cancer  85% received chemotherapy (9 cases (3.7%) had an unknown chemo start date; 7 cases (2.9%) had a chemo start date beyond 120 days )  9% refused chemotherapy  3% had medical contraindications  3% have no documentation about chemotherapy Analysis of characteristics of ‘concordant’ vs. ‘non- concordant’ groups yielded no significant results.