Assurance de qualité pour le cancer rectal – phase 2 ...

KCE Reports 81 PROCARE – phase 2 29Exclusion criteria:• patients with an incidence date before February 1 st 2003 (date at whichthe administrative code became available)• patients with cT, cN and/or cStage unknownRESULTSOverall, 65% of patients with rectal cancer cT3-4, cN+ and/or cStage IV were discussedat the MDT in 2003 (Table 16). The results of 2004 are not presented since the BCRdata were not complete for 2004 at the time of the study. Of the 1473 patients with acorrect incidence date, it was not possible to retrieve the cStage and/or cN and/or cTfor 617 patients (total missings: 617/7074, 9%).Discussion at the MDT is measurable for 100 centres using the administrative database.Thirty-two of the 101 centres have a score of 100%, while 13 centres have a score of0%. All these 13 centres treated less than 5 eligible patients. Sixty-four centres have ascore above the weighted (65%; 95%CI 61 – 69%) and unweighted mean (66%; 95%CI59 – 73%).The QI is not measurable for the prospective cohort, since this information is notregistered.Table 16. Number of patients with rectal cancer (cT3-4, cN+ and/or cStageIV) discussed at a multidisciplinary meeting in 2003, measured withadministrative data.NPatients with rectal cancer: cT3-4, cN+ and/or cStage IV (denominator) 673Proportion discussed at the MDT (numerator) 435 (65%)DiscussionAt present, only one general QI (local recurrence rate) is measurable using thePROCARE database, while one other QI will only be measurable in the future (overall5-year survival by stage) (Table 17). Using administrative databases, overall 5-yearsurvival by stage and discussion at a multidisciplinary team meeting are both measurable.Disease-specific 5-year survival by stage is not measurable for both databases. However,this QI will be replaced by the relative 5-year survival by stage, which is (potentially)measurable for both databases. Another option would be to add a specific code to thePROCARE data entry form that registers the cause of death both in the postoperativeperiod and during follow-up (providing a choice between cancer-related and cancerunrelatedcause of death). However, in this case an important precondition is tocontinue the registration of events after local or distant recurrence. Obviously, this isnot a solution for the administrative database.For the interpretation of the overall survival, it is important to take into account thepostoperative mortality, which has an important impact on the 1-year survival.Postoperative mortality is measured in QI 1234 (see below).Finally, QI 1114 can be rendered measurable using the PROCARE database by adding aspecific code to the PROCARE data entry form, or by linking the PROCARE databaseto the administrative databases using the unique patient identification number. Thelatter option is preferred, since it would reduce the registration burden of theparticipating centres. However, in view of a changing law (making a discussion at theMDT obligatory for all oncologic patients) and in view of the inability to check thequality of the multidisciplinary discussion itself, one can discuss on the value of thisindicator as a quality indicator.