Fox Chase Cancer Center Partners, Rockledge, PA 19046, USA.
Clin Colorectal Cancer. 2011 Jun;10(2):113-6. doi: 10.1016/j.clcc.2011.03.007. Epub 2011 Apr 22.
Fox Chase Cancer Center Partners (FCCCP) performs an annual quality review of affiliate practices based on National Comprehensive Cancer Network (NCCN) guidelines. Given recent treatment advances, we initiated this medical record review in elderly patients with stage III colon cancer to measure compliance with these guidelines.
Medical records of 124 patients age ≥ 65 diagnosed with stage III colon cancer between 2003 and 2006 were reviewed. Metrics were developed and based on NCCN guidelines for workup and staging, treatment, and gerontology. Documentation was reviewed via paper (13 sites) and electronic record (2 sites).
High compliance with staging and workup guidelines was noted with chest imaging (100%), stage (98%), computed tomography (CT) of the abdomen/pelvis (93%), pathology (91%), and carcinoembryonic antigen (CEA; 91%). Activities of daily living were documented commonly (83%) but colonoscopy less (75%). Age and life expectancy were discussed with the patient in only 49%. Nearly all patients (123 of 124 patients) received adjuvant chemotherapy, with 76 patients (61%) receiving oxaliplatin. Common regimens were FOLFOX (oxaliplatin plus infusional/bolus 5-fluorouracil and folinic acid) 54%, 5-fluorouracil/leucovorin (5-FU/LV; 19%), and capecitabine (12%). Reasons for excluding oxaliplatin were comorbidity (68%), age (19%), and not specified (13%). Three-quarters of the patients had ≥ 12 lymph nodes sampled and 56% identified the radial margin. Nearly all patients (115 = 93%) received surveillance with history and physical and CEA. Surveillance CT was performed in 78% of the patients.
A quality review of community oncology practices can assess implementation of treatment advances. Guideline compliance for elderly patients with stage III colon cancer is generally high. Forty percent did not receive oxaliplatin and documentation of life expectancy was infrequent. Further study of oncologist decision making for elderly colon cancer patients is warranted.
福克斯蔡斯癌症中心合作伙伴（FCCCP）根据国家综合癌症网络（NCCN）指南，对附属实践进行年度质量审查。鉴于最近的治疗进展，我们在老年 III 期结肠癌患者中启动了这项病历审查，以衡量这些指南的遵守情况。
对 2003 年至 2006 年间诊断为 III 期结肠癌且年龄≥65 岁的 124 名患者的病历进行了回顾。根据 NCCN 指南制定了检查和分期、治疗和老年病学的指标。通过纸质文件（13 个站点）和电子病历（2 个站点）审查文件。
胸部成像（100%）、分期（98%）、腹部/骨盆 CT（93%）、病理学（91%）和癌胚抗原（CEA；91%）的分期和检查指南得到了高度遵守。日常生活活动记录通常很常见（83%），但结肠镜检查较少（75%）。只有 49%的患者讨论了年龄和预期寿命。几乎所有患者（124 例患者中的 123 例）均接受了辅助化疗，其中 76 例患者（61%）接受了奥沙利铂。常见方案为 FOLFOX（奥沙利铂联合输注/推注氟尿嘧啶和亚叶酸）54%、5-氟尿嘧啶/亚叶酸（5-FU/LV；19%）和卡培他滨（12%）。排除奥沙利铂的原因是合并症（68%）、年龄（19%）和未指定（13%）。四分之三的患者有≥12 个淋巴结取样，56%的患者确定了放射状边缘。几乎所有患者（115 例患者中的 93%）都接受了病史和体格检查以及 CEA 的监测。78%的患者进行了 CT 监测。
对社区肿瘤学实践的质量审查可以评估治疗进展的实施情况。老年 III 期结肠癌患者的指南遵守情况总体较高。40%的患者未接受奥沙利铂治疗，且预期寿命的记录很少。需要进一步研究老年结肠癌患者的肿瘤学家决策。
