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CP 3 R Reports for Population Based Studies

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  1. CP3R Reports for Population Based Studies Presented at the NAACCR Annual Conference Quebec City June 22, 2010

  2. What are CP3R Reports? • Cancer Program Practice Profile Reports • Developed by the Commission on Cancer • Web based comparative reports for COC approved facilities to assess local adherence to standards of care • Designed to implement concepts of best practices that will diminish disparities in cancer care across COC approved programs

  3. 6 currently defined measures • Breast cancer – Radiation therapy is administered within 1 year to women < age 70 who receive BCC • Breast cancer – Combination chemo is received within 4 mos. by women who are • < age 70 • T1cN0M0 or Stage II or Stage III • Hormone receptor negative

  4. 6 currently defined measures • Breast cancer – Hormone therapy is received within 1 year by women who are • T1cN0M0 or Stage II or Stage III • Hormone receptor positive • Colon cancer – At least 12 regional lymph nodes are removed & examined for resected colon cancers

  5. 6 currently defined measures • Colon cancer – Adjuvant chemo is received within 4 mos. by patients who are • < age 80 • Stage III (lymph node positive) • Have surgical resection • Rectal cancer – Radiation therapyis administered within 6 mos. to patients • < age 80 • T4N0M0 or Stage III • Have surgical resection

  6. Hospital Registry Query • Report requested by KY hospitals • To identify all eligible patients for each CP3R measure and • To calculate percentage of concordant vs. non-concordant cases for the hospital

  7. Sample query: Stg III Colon • Age between 18-79 • Seq. number = 00 or 01 • Site code = C18.0 or C18.2-C18.9 • Behavior code = 3 • Diagnosis date between 1/1/2007 and 12/31/2007 • Histology = epithelial tumors (8000, 8001, …) (List provided by COC)

  8. Sample query (continued) • pTNM Stage Group = III, IIIA, IIIB, or IIIC • Surgery at the Primary Site = 30-90 • Regional Nodes Positive = 1-90, 95, or 97 • Patient alive for at least 120 days after surgery

  9. Sample hospital report

  10. Central Registry application • Can assess concordance in KY with national standards of care • Can determine ‘concordant’ vs. ‘non- concordant’ groups and then examine differences in age, race, area of residence, etc. in a population

  11. Central Registry Query • Modifications needed for CCR query • Delete class of case condition • Add ‘State at Diagnosis’ = KY • Use Stage Group criteria based on derived Collaborative Stage instead of AJCC Stage variables

  12. Example: 2007 Stage III Colon Cancer Cases • Initial query: 243 eligible cases • Compared Derived Stage Group to pTNM Stage Group • 3 cases were pTNM Stage IV (metastatic); thus deleted • Final KY 2007 Stage III Colon cases (eligible per CP3R criteria) was 240.

  13. Initial Assessment • No chemotherapy • None given 31 • Recommended, unk. if given 14 • Unknown if rec. or given 25 • Total ‘non-concordant’ 70 29.2% • Chemotherapy considered or given • Chemo given 161 • Chemo contraindicated 1 • Chemo refused 8 • Total ‘concordant’ 170 70.8%

  14. Follow Back • Text documentation was reviewed on all cases where chemo was refused; all were verified. • All cases where chemo was not reported to the CCR were followed back, using • Calls to hospital registrars • Calls, letters, & electronic access to physician offices • Calls, letters, & electronic access to OP facilities • On site visits • Calls and letters to out of state CCR contacts, registrars and physicians

  15. Final results

  16. Chemo Time Frame Issues • 9 cases where chemo was found to be given, no date for chemo could be found • 7 cases had chemotherapy received more than 120 days beyond diagnosis date • Of these, 4 patients had various co-morbidities that delayed their chemotherapy start date, even though it had been recommended within the time frame. • 2 cases that had chemotherapy more than 250 days after diagnosis were reviewed and recoded; the chemo was determined to be subsequent treatment.

  17. Concordant vs. Non-concordant

  18. Other Findings • More information on chemotherapy given, refused, or contraindicated was found on 62 patients • 33 were reported to KCR by COC hospitals • 29 were reported by non-COC facilities • It took approximately 70 hours to follow back on 70 cases.

  19. Summary In 2007, of Kentuckians with Stage III colon cancer • 85% received chemotherapy (9 cases (3.7%) had an unknown chemo start date; 7 cases (2.9%) had a chemo start date beyond 120 days ) • 9% refused chemotherapy • 3% had medical contraindications • 3% have no documentation about chemotherapy Analysis of characteristics of ‘concordant’ vs. ‘non-concordant’ groups yielded no significant results.