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

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38 PROCARE – phase 2 KCE reports 81Of course, many of these procedures – such as CT liver, CT/RX thorax, TRUS, etc. –are necessary to decide on further treatment/surgery, and should therefore bepreformed in all patients [1].Table 25. Measurability of selected QI on diagnosis and staging.QI Prospective Db Administrative DbMeasurable? If not: reason? Measurable? If not: reason?1211 Yes - No Clinical data: no code1212 No No specific code No Code not obligatory1213 Yes - Yes -1214 Yes - No No specific code1215 Yes - No No specific code1216 Yes - No Clinical data: no code1217 Yes - Yes -3.2.2.3 Quality indicators related to neoadjuvant treatmentProportion of cStage II-III patients that received a short course ofneoadjuvant pelvic RTDEFINITIONNumerator: all patients with cStage II or III RC that underwent surgery and received ashort course of neoadjuvant pelvic RT (with or without chemotherapy).Denominator: all patients with cStage II or III RC that underwent surgery.Exclusion:• patients with cStage other than II and III• cStage II and III patients not treated with surgeryRESULTSSix percent (95%CI 4 – 9%) of the PROCARE patients with cStage II-III that underwentsurgery received a short course of neoadjuvant pelvic radiotherapy, compared to 52%(95%CI 47 – 57%) of the patients that received a long course (Table 26). Thirteenpercent received another course of neoadjuvant pelvic radiotherapy, while 28%received no neoadjuvant radiotherapy. The total number of missing data was 430/1071or 40% (including 335 patients with unknown cStage).Short and long course neoadjuvant radiotherapy are measurable for 48 centres usingthe prospective database. In 6 centres all cStage II-III patients are treated with a longcourse of neoadjuvant radiotherapy. However, all 6 centres have 3 eligible patients orless. On the contrary, in 10 centres no cStage II-III patients are treated with a longcourse. Nine of these centres have 10 eligible patients or less. In 38 centres, no patientis treated with a short course of neoadjuvant radiotherapy, while in 5 centres morethan 10% of cStage II-III patients is treated with a short course.Importantly, for the interpretation of these results risk-adjustment (tumour localisation,cCRM, age, comorbidities) is necessary.The QI is not measurable for the administrative cohort due to an inability to distinguisha short or long course from another course of radiotherapy (see appendix).
KCE Reports 81 PROCARE – phase 2 39Table 26. Number of patients that received a short or long course ofneoadjuvant pelvic radio(chemo)therapy, measured with prospectivePROCARE data.cStageI II III X II-IIIPatients with rectal cancer 107 160 357 335 517Patients with rectal cancer that underwent surgery 107 160 356 330 516Patients with a short course (numerator QI 1221) 2 7 19 17 26 (6%)Patients with a long course (numerator QI 1222) 7 42 178 104 220 (52%)Patients with other course 5 13 43 23 56No neoadjuvant radiotherapy 88 57 62 153 119Patients with neoadjuvant radiotherapy unknown or regimen 5 41 54 33 95unknown (missing data) **The denominator is calculated by subtracting the missing data from the proportion of patientsthat underwent surgery (see appendix for algorithm).Proportion of cStage II-III patients that received a long course ofneoadjuvant pelvic RTDEFINITIONNumerator: all patients with cStage II or III RC that underwent surgery and that receiveda long course of neoadjuvant pelvic RT (with or without chemotherapy).Denominator: all patients with cStage II or III RC that underwent surgery.Exclusion:• patients with cStage other than II and III• cStage II and III patients not treated with surgeryRESULTSSee previous QI.Proportion of cStage II-III patients that received neo-adjuvantchemoradiation with a regimen containing 5-FUDEFINITIONNumerator: all patients with cStage II or III RC that underwent surgery and that receivedneoadjuvant CRT with a regimen containing 5-FU.Denominator: all patients with cStage II or III RC that underwent surgery and thatreceived neoadjuvant CRT.Exclusion:• patients with cStage other than II and III• cStage II and III patients not treated with surgery• cStage II and III patients receiving neoadjuvant radiotherapy orchemotherapy as a monotherapyRESULTSIn the prospective cohort 95% (95%CI 90 – 100%) of the cStage II-III patients thatunderwent surgery and received neoadjuvant chemoradiotherapy, received achemotherapy regimen with 5-FU (Table 27). However, a high number of missing datawas identified, which is due to the complete absence of a specific chemotherapy form inthe first data entry version and the complex data entry form for chemotherapy atpresent. For 335 patients the cStage was unknown. For 18 of the 516 patientsundergoing surgery, no information was available on neoadjuvant treatment. Above this,for 227 of the 290 patients receiving neoadjuvant chemoradiation, no information wasavailable on the administered regimen (total missings: 580/1017, 54%).
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