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

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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.
KCE Reports 81 PROCARE – phase 2 55Using the administrative database, this QI is measurable for 97 centres. Forty centreshave a score of 100%, while in 31 centres 50% or less of the cStage IV patients receivechemotherapy. Sixty-two and 53 centres have a score above the weighted (63%; 95%CI59 – 67%) and unweighted mean (69%; 95%CI 62 – 76%) respectively.For the correct interpretation of these results, risk-adjustment (age, comorbidities) isnecessary.Table 46. Proportion of patients that received chemotherapy, measuredwith prospective PROCARE data.cStage0 I II III IV X AllPatients with rectal cancer1 107 160 357 111 335 1071(denominator)Proportion that received chemotherapy(numerator)0 35 90 291 68 (61%) 190 674Rate of acute grade 4 chemotherapy-related complications in stageIV patientsDEFINITIONNumerator: all patients with cStage IV RC that received chemotherapy and with acutegrade 4 chemotherapy-related complications.Denominator: all patients with cStage IV RC that received chemotherapy.Exclusion:• patients with cStage other than cStage IV• cStage IV patients not treated with chemotherapyRESULTSTwo percent of the cStage IV patients that received chemotherapy had acute grade 4complications (Table 47). The exact number of missing data cannot be calculated forthis QI. For 335 patients the cStage was unknown. Of the 68 cStage IV patients thatreceived chemotherapy, 1 had grade 4 complications, 1 had grade 3 complications, and5 had complications with an unknown grade (i.e. missings). For the other 61 cStage IVpatients, it is impossible to differentiate between no complications or a missing value,since the default value of the variable was ‘0’ (i.e. missing values also received a value ‘0’)(see appendix). Therefore, the total number of missing data is at least 340/1071 or 32%.Since only one patient with a grade 4 complication was identified, a per-centre-analysisis irrelevant.Due to the absence of a specific code for grade 4 chemotherapy-related complications,this QI is not measurable in the administrative cohort.Table 47. Proportion of patients that received chemotherapy with acutegrade 4 chemotherapy-related complications, measured with prospectivePROCARE data.cStage0 I II III IV X AllPatients with rectal cancer 1 107 160 357 111 335 1071Proportion that received chemotherapy with 0 35 87 278 63 187 650adequate information on complications(denominator)Proportion with acute grade 4 complications(numerator)0 1 0 0 1 (2%) 0 2DiscussionBoth QI are measurable using the prospective database, while only one QI ismeasurable using the administrative databases (Table 48).Only minor adaptations are needed to optimise these QI. For QI 1251 a ‘corrected’cStage should be used, taking into account peroperative findings for metastasis.
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