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

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42 PROCARE – phase 2 KCE reports 81Exclusion:• patients with cStage other than II and III• cStage II and III patients not treated with surgery• cStage II and III patients not treated with a long course of neoadjuvant(chemo)radiotherapyRESULTSIn the prospective cohort 64% of the cStage II-III patients that received a long course ofneoadjuvant (chemo)radiotherapy was operated 6-8 weeks after completion of the(chemo)radiotherapy (Table 30). About one-fourth was operated within 6 weeks aftercompletion, while 11% was operated more than 8 weeks after completion. For 335patients the cStage was unknown. For 20 of the 516 patients undergoing surgery, noinformation was available on neoadjuvant radiotherapy. Above this, for 75 of the 377patients receiving neoadjuvant (chemo)radiotherapy, no information was available onthe course of the radiotherapy. Finally, for 4 of the 220 patients receiving a long courseof neoadjuvant (chemo)radiotherapy, no information was available on the treatmentdates (total missings: 434/1071, 41%).This QI was measurable for 38 centres using the prospective database. Eight centreshave a score of 100%, while 15 centres have a score of 50% or less. Twenty centreshave a score above the weighted (64%; 95%CI 58 – 71%) and unweighted mean (62%;95%CI 52 – 72%). Again, 31 centres included less than 10 eligible patients.The identification of a long course of RT, i.e. at least 25 fractions of 1.8 Gy, isimpossible in the administrative databases. The QI is therefore not measurable for theadministrative cohort.Table 30. Number of patients that received a long course of neoadjuvant(chemo)radiotherapy and was operated 6-8 weeks after completion of the(chemo)radiotherapy, measured with prospective PROCARE 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 that received a long course of neoadjuvant7 42 178 104 220chemoradiotherapyPatients with a known surgery date and end date of6 42 174 97 216(chemo)radiotherapy (denominator)Patients that were operated 6-8 weeks after completion 4 28 111 62 139 (64%)(numerator)Patients that were operated 8 weeks after completion 0 3 21 9 24Rate of acute grade 4 radio(chemo)therapy-related complicationsDEFINITIONNumerator: all patients with RC that received neoadjuvant (C)RT and had acute grade 4complications.Denominator: all patients with RC that received neoadjuvant (C)RT.Exclusion:• patients with cStage other than II and III• cStage II-III patients not treated with (chemo)radiotherapyRESULTSDue to the absence of a specific code for grade 4 radio(chemo)therapy-relatedcomplications, this QI is not measurable in both the prospective and administrativecohort.
KCE Reports 81 PROCARE – phase 2 43DiscussionTwo QI (continuous 5-FU infusion and grade 4 radio[chemo]therapy-relatedcomplications) are not measurable with the prospective database due to the absence ofcodes registering the necessary information (Table 31). Both QI are also not measurablewith the administrative databases. To capture the necessary information for both QI,specific codes need to be added to the PROCARE data entry form. Above this, thechemotherapy section of the form needs to be introduced to the participants ofPROCARE and to be modified to allow an unambiguous and more complete registrationof all necessary chemotherapy-related information.Five QI are not measurable with the administrative databases, because the dose andnumber of fractions of the radiotherapy regimen cannot be retrieved withadministrative codes. One other QI (grade 4 radio[chemo]therapy-relatedcomplications) is not measurable, because no specific administrative codes exists forgrade 4 complications.In the prospective database, a high number of missing values was identified for theradiotherapy regimen. Above this, no information on the prescribed radiotherapyregimen is available (only the administered regimen is registered), which is moreindicative of the appropriateness of the treatment. Therefore, a specific variableregistering the prescribed radiotherapy regimen should be added to the radiotherapysection of the PROCARE data entry form.Most of the selected QI are defined for cStage II-III patients that underwent surgery.However, it is clear that these QI apply to all cStage II-III patients, irrespective of thereceival of surgery (taking into account age, fitness, stage, tumour localisation).Table 31. Measurability of selected QI on neoadjuvant treatment.QI Prospective Db Administrative DbMeasurable? If not: reason? Measurable? If not: reason?1221 Yes - No No specific code1222 Yes - No No specific code1223 Yes - Yes -1224 No No specific code No No specific code1225 Yes - No No specific code1226 Yes - No No specific code1227 No No code No No code3.2.2.4 Quality indicators related to surgeryProportion of R0 resectionsDEFINITIONNumerator: all cStage I-III patients with RC that underwent radical resection and had aR0 resection.Denominator: all cStage I-III patients with RC that underwent radical resection.Exclusion:• patients with cStage IV• patients undergoing local surgery or no surgeryRESULTSOf the cStage I-III patients that underwent radical resection, 93% had an R0 resection inthe prospective cohort (Table 32). For 335 patients the cStage was unknown. For 10 ofthe 612 patients that underwent radical resection, no information was available on thetype of resection (total missings: 345/1071, 32%).The proportion of R0 resections is measurable for 52 centres using the prospectivedatabase. Thirty-one centres have 100% R0 resections, while 7 centres have a score of80% or less. Thirty-three and 34 centres have a score above the weighted (93%; 95%CI91 – 95%) and unweighted mean (93%; 95%CI 90 – 96%) respectively. For the correctinterpretation of these results, risk-adjustment (stage, cCRM) is necessary.
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35. Etude relative aux coûts poten
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