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

54 PROCARE – phase 2 KCE reports 81Table 44. Number of acute grade 4 chemotherapy-related complications,measured with prospective PROCARE data.NPatients with (y)pStage 0-III rectal cancer 841Patients having adjuvant chemo(radio)therapy and with adequate information on adverse 47events (denominator)Patients with acute grade 4 complications (numerator) 0 (0%)DiscussionAll five QI are measurable using the prospective database, but not measurable using theadministrative databases (Table 45). The most important reason for not beingmeasurable is the absence of an administrative code for R0 resections.An important problem with the interpretation of these QI is the high number of missingvalues, ranging from 34% for QI 1242 to 54% for QI 1241. Several explanations can begiven. First, mainly surgeons and pathologists transmitted their data to the PROCAREregister during the study period. Also, there was no specific chemotherapy form in thefirst version of the data entry. At present, data from oncologists and gastroenterologists(including data on chemotherapy) are often lacking. Therefore, more effort should bemade by the data managers to pursue the necessary data. Second, the chemotherapysection of the data entry form does not allow an unambiguous analysis of chemotherapyregimens or other chemotherapy-related information at present. This section thereforeneeds a careful revision.Table 45. Measurability of selected QI on adjuvant treatment.QI Prospective Db Administrative DbMeasurable? If not: reason? Measurable? If not: reason?1241 Yes - No No code1242 Yes - No No code1243 Yes - No No code1244 Yes - No No code1245 Yes - No No code3.2.2.6 Quality indicators related to palliative treatmentRate of cStage IV patients receiving chemotherapyDEFINITIONNumerator: all patients with cStage IV RC receiving chemotherapy.Denominator: all patients with cStage IV RC.Exclusion:• patients with cStage other than cStage IVRESULTSOf the cStage IV patients in the prospective cohort, 61% received chemotherapy (Table46). For 335 patients the cStage was unknown (total missings: 335/1071, 31%). Abovethis, the number of cStage IV patients can be underestimated, since in some cM0patients metastases are identified peroperatively. Ideally, a ‘corrected’ cStage should beused that takes into account the peroperative findings.In the administrative cohort, 63% of the cStage IV patients (n = 559) receivedchemotherapy. For 4437 patients the cStage was unknown (total missings: 4437/7074,63%).Chemotherapy for cStage IV patients is measurable for 39 centres using the prospectivedatabase. Fifteen centres have a score of 100%, while in 16 centres 50% or less of thecStage IV patients receive chemotherapy. Twenty-three centres have a score above theweighted (61%; 95%CI 52 – 71%) and unweighted mean (59%; 95%CI 45 – 72%).Importantly, the range of included eligible patients is 1 – 13 per centre. Thirty-sevencentres included 7 or less eligible patients.