Assessing the Quality of Cancer Care An Approach to Measurement in Georgia (2005) / Chapter Skim
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5 Diagnosing Cancer
5 Diagnosing Cancer
Pages 108-159
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From page 108... ...
the timely gathering of appropriate diagnostic and surgical specimens for histological assessment, (2) clear, reliable, and standardized pathology reporting on surgical specimens, and (3)
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From page 109... ...
The next five measures can be used by Georgia to track the quality of the pathology reports on cancer surgical specimens, which clinicians depend on to assess the extent of the cancer and to advise patients on treatment options. The final set of four measures will help the state ensure adequate treatment planning by monitoring whether health care providers document patients' cancer stage before initiating chemotherapy or radiation treatment.
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From page 110... ...
To monitor the appropriate collection and histological assessment or evaluation of breast and colorectal cancer surgical specimens, the committee recommends that the GCC adopt the following measures: · Measure 5-3 -- Tumor-free surgical margins in breast-conserving surgery for breast cancer -- the proportion of patients undergoing breastconserving surgery whose surgical margins are free of tumor after the last surgical procedure. · Measure 5-4 -- Appropriate histological assessment of breast cancer-the proportion of Stage I and Stage II breast cancer cases with sentinel node biopsy or with histological assessment of 10 or more axillary lymph nodes.
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From page 111... ...
A recent, multivariate analysis of 4,465 women with invasive breast cancer suggests that 6- to 12-month delays to diagnosis of asymptomatic breast cancer are associated with increased risk of lymph node metastases and larger tumor size (Olivotto et al., 2002)
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From page 112... ...
A 2001 survey of medical directors of community health centers in 10 states found that about 40 percent of uninsured patients had difficulty getting specialty referrals, including referrals for follow-up of abnormal screening tests (Gusmano et al., 2002)
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From page 113... ...
Data on the use of needle biopsy before breast cancer surgery are not available. Cancer Surgical Specimens Three of the recommended quality measures pertain to the collection and histological assessment or evaluation of surgical specimens taken from patients who undergo surgery for breast or colorectal cancer.
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From page 114... ...
Assessment of lymph nodes after colorectal cancer surgery. Most colorectal cancer patients undergo surgical resection -- an estimated 92 percent of colon cancer patients and 84 percent of rectal cancer patients (Compton, 2003)
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From page 115... ...
· Stage IIIA -- Locally advanced cancer; includes tumors larger than 5 cm, and tumors less than 5 cm in diameter with spread to the axillary nodes where the nodes are attached to each other or to other structures. · Stage IIIB -- Locally advanced cancer; includes tumors with spread to the lymph nodes near the breast (skin or chest wall, including the ribs and the muscles in the chest)
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From page 116... ...
· Measure 5-6 -- Pathology laboratories' compliance with reporting standards for cancer surgical specimens -- the proportion of pathology laboratories that report CAP data elements as required by the Commission on Cancer. The remaining four measures track whether pathology reports include the key data elements currently mandated by the Commission on Cancer for breast, colorectal, lung, and prostate cancers: · Measure 5-7 -- Adequacy of pathology reports on breast cancer surgical specimens -- the proportion of pathology reports on invasive breast cancer surgical specimens that include CAP data elements as required by the Commission on Cancer.
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From page 117... ...
CAP recommends, but does not require, that its certified laboratories use the checklist. As of 2004, the Commission on Cancer, a multidisciplinary program of the American College of Surgeons, has required that pathology laboratories at Commission on Cancer-certified cancer centers report the scientifically validated data elements in the CAP checklists for cancer-directed surgical specimens.
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From page 118... ...
118 ASSESSING THE QUALITY OF CANCER CARE FIGURE 5-1 Pathology report checklist for a prostate cancer surgical specimen, College of American Pathologists Surgical Pathology Cancer Case Summary (Checklist) Protocol revision date: January 2004 Applies to invasive carcinomas only Based on AJCC/UICC TNM, 6th edition PROSTATE GLAND: Radical Prostatectomy Patient name: Surgical pathology number: Note: Check 1 response unless otherwise indicated.
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From page 119... ...
but not both sides ("lobes") ___ pT2c: Bilateral disease pT3: Extraprostatic extension ___ pT3a: Extraprostatic extension ___ pT3b: Seminal vesicle invasion ___ pT4: Invasion of bladder and/or rectum Regional Lymph Nodes (pN)
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From page 120... ...
* Data elements with asterisks are not required for accreditation purposes for the Commission on Cancer.
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From page 121... ...
Adequacy of pathology reports on colorectal cancer surgical specimens. Although data are limited, there are studies showing considerable variability in colorectal cancer pathology reporting including failure to document critical data.
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Georgia Regional the Joseph 2005)
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From page 123... ...
Adequacy of pathology reports on lung cancer surgical specimens. Surgical resection is the primary treatment for lung cancer (NCCN, 2004d)
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From page 124... ...
The IOM committee recommends that the GCC adopt four quality measures to help Georgia ensure that patients' cancers are appropriately staged before chemotherapy or radiation treatment begins: · Measure 5-11 -- Breast cancer stage determined before treatment-the proportion of new breast cancer cases with medical chart documentation of pathologic stage before chemotherapy or radiation treatment is initiated. · Measure 5-12 -- Colorectal cancer stage determined before treatment -- the proportion of new colorectal cancer cases with medical chart documentation of pathologic stage before chemotherapy or radiation treatment is initiated.
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From page 125... ...
. DATA SOURCES The data for 12 of the 14 measures pertaining to quality of cancer diagnosis must be abstracted from pathology reports and medical records (Table 5-2)
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From page 126... ...
Data Comparison are Diagnosis and SEER National BCSC American sources. Cancer of collection of data of Consortium; data Potential Benchmarking CoC College = Quality current CAP to the descriptions Surveillance of for B Medical records Cancer; Cancer and on A enhancements Measures Breast = that Georgia SEER/ Medicare Appendixes BCSC Commission and indicates Georgia mammog- raphy registry Recommended Georgia-Based Registry; Surgeons Sources Sources, of for symbol Cancer Potential Data GCCR and Georgia SEER Data The College and Sources available.
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From page 127... ...
Adequacy of Pathology Reports on Lung Cancer Surgical Specimens Measure 5-10. Adequacy of Pathology Reports on Prostate Cancer Surgical Specimens Measure 5-11.
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From page 128... ...
A recent, multivariate analysis of 4,465 women with invasive breast cancer suggests that 6- to 12-month delays to diagnosis of asymptomatic breast cancer are associated with increased risk of lymph node metastases and larger tumor size. Delays are also associated with significant anxiety for the patient.
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From page 129... ...
2000. Breast Cancer Diagnosis and Treatment.
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From page 130... ...
Knowledge vs. practice Unknown Approach to calculating the measure Numerator Number of women who have a needle biopsy of the breast at least 1 day prior to breast cancer surgery Denominator Number of women who undergo breast cancer surgery Potential data source(s)
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From page 131... ...
Breast Cancer Screening and Diagnosis Guidelines.
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From page 132... ...
Approach to calculating the measure Numerator Number of breast-conserving cancer surgery patients whose surgical margins are free of tumor after their last surgical procedure Denominator Number of breast-conserving cancer surgery patients Potential data source(s) Special studies of pathology reports and medical records.
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From page 133... ...
2003. Concordance with breast cancer pathology reporting practice guidelines.
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From page 134... ...
practice Numerous studies have documented that histological assessments are not performed as recommended and that use declines with patients' age. Approach to calculating the measure Numerator Number of Stage I and Stage II breast cancer cases with sentinel node biopsy or with histological assessment of 10 or more axillary lymph nodes Denominator Number of Stage I and Stage II breast cancer cases Potential data source(s)
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From page 135... ...
2002. Prognostic significance of the number of axillary lymph nodes removed in patients with node negative breast cancer.
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From page 136... ...
Approach to calculating the measure Numerator Number of colorectal cancer surgery patients with a surgical resection that included at least 12 lymph nodes Denominator Number of colorectal cancer surgery patients Potential data source(s) Surveillance, Epidemiology, and End Results Program (SEER)
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From page 137... ...
2003. Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089.
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From page 138... ...
The Commission on Cancer mandates that pathology laboratories at Commission on Cancer-approved cancer programs report the mandatory data elements in the CAP checklists for cancer-directed surgical specimens (the CAP checklist reporting format is optional)
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From page 139... ...
2003. Required Data Elements from CAP Cancer Checklists Mandated for Use by the American College of Surgeons Commission on Cance, Effective January 1, 2004.
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From page 140... ...
Approach to calculating the measure Numerator Number of pathology reports on invasive breast cancer surgical specimens that include CAP data elements as required by the Commission on Cancer Denominator Number of pathology reports on invasive breast cancer surgical specimens Potential data source(s) Special studies of pathology reports; medical records Comments Measurement goal should be 100 percent.
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From page 141... ...
2003. Concordance with breast cancer pathology reporting guidelines.
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From page 142... ...
Approach to calculating the measure Numerator Number of pathology reports on colorectal cancer surgical specimens that include CAP data elements as required by the Commission on Cancer Denominator Number of pathology reports on colorectal cancer surgical specimens Potential data source(s) Special studies of pathology reports; medical records Comments Measurement goal should be 100 percent.
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From page 143... ...
2003. Cancer Program Standards, 2004.
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From page 144... ...
Approach to calculating the measure Numerator Number of pathology reports on lung cancer surgical specimens that include CAP data elements as required by the Commission on Cancer Denominator Number of pathology reports on lung cancer surgical specimens Potential data source(s) Special studies of pathology reports; medical records Comments Measurement goal should be 100 percent.
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From page 145... ...
2000. Pathological examination and the reporting of lung cancer specimens.
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From page 146... ...
Approach to calculating the measure Numerator Number of pathology reports on prostate cancer surgical specimens that include CAP data elements are required by the Commission on Cancer Denominator Number of pathology reports on prostate cancer surgical specimens Potential data source(s) Special studies of pathology reports; medical records Comments Measurement goal should be 100 percent.
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From page 147... ...
. -- PROSTATE GLAND: Radical prostatectomy -- PROSTATE GLAND: Needle Biopsy, transurethral prostatic resection, enucleation specimen.
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From page 148... ...
The researchers found that tumor grade was not documented in the charts of more than half of the cases. Approach to calculating the measure Numerator Number of new breast cancer cases with medical chart documentation of pathologic stage before chemotherapy or radiation treatment is initiated Denominator Number of new breast cancer cases with chemotherapy or radiation treatment Data source Medical records Comments - Limitations - Potential benchmark Baseline studies of medical records source(s)
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From page 149... ...
2004. Clinical Practice Guidelines in Oncology v.1.2004.
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From page 150... ...
The proportion of Georgians with colorectal cancer that is treated before the stage is determined is not known. Approach to calculating the measure Numerator Number of new colorectal cancer cases with medical chart documentation of pathologic stage before chemotherapy or radiation is initiated Denominator Number of new colorectal cancer cases with chemotherapy or radiation treatment Potential data source(s)
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From page 151... ...
2004. Pathologic staging of colorectal cancer.
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From page 152... ...
Approach to calculating the measure Numerator Number of new lung cancer cases with medical chart documentation of pathologic stage before chemotherapy or radiation treatment is initiated Denominator Number of new lung cancer cases with chemotherapy or radiation treatment Potential data source(s) Medical records Comments - Limitations - Potential benchmark Baseline studies of medical records source(s)
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From page 153... ...
Non-Small Cell Lung Cancer.
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From page 154... ...
Approach to calculating the measure Numerator Number of new prostate cancer cases with medical chart documentation of pathologic stage before chemotherapy or radiation treatment is initiated Denominator Number of new prostate cancer cases with chemotherapy or radiation treatment Potential data source(s) Medical records Comments - Limitations - Potential benchmark Baseline studies of medical records source(s)
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From page 155... ...
2004. The contemporary management of prostate cancer in the United States: lessons from the cancer of the prostate strategic urologic research endeavor (CAPSURE)
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From page 156... ...
2003. Required Data Elements from CAP Cancer Checklists Mandated for Use by the American College of Surgeons Commission on Cancer Effective January 1, 2004.
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From page 157... ...
1998. The effect of four interventions on the informational content of histopathology reports of resected colorectal carcinomas.
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From page 158... ...
2003. Colon cancer survival is associated with increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089.
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From page 159... ...
2002. Prognostic significance of the number of axillary lymph nodes removed in patients with node-negative breast cancer.
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