Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
Department of Haematology and Medical Oncology, Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain.
Ann Oncol. 2014 Aug;25(8):1485-92. doi: 10.1093/annonc/mdu039. Epub 2014 Mar 26.
Colorectal cancer is one of the most common cancers in Europe. Over the past few decades, important advances have been made in screening, staging and treatment of colorectal cancer. However, considerable variation between and within European countries remains, which implies that further improvements are possible. The most important remaining question now is: when are we, health care professionals, delivering the best available care to patients with colon or rectal cancer? Currently, quality assurance is a major issue in colorectal cancer care and quality assurance awareness is developing in almost all disciplines involved in the treatment of colorectal cancer patients. Quality assurance has shown to be effective in clinical trials. For example, standardisation and quality control were introduced in the Dutch TME trial and led to marked improvements of local control and survival in rectal cancer patients. Besides, audit structures can also be very effective in monitoring cancer management and national audits showed to further improve outcome in colorectal cancer patients. To reduce the differences between European countries, an international, multidisciplinary, outcome-based quality improvement programme, European Registration of Cancer Care (EURECCA), has been initiated. In the near future, the EURECCA dataset will perform research on subgroups as elderly patients or patients with comorbidities, which are often excluded from trials. For optimal colorectal cancer care, quality assurance in guideline formation and in multidisciplinary team management is also of great importance. The aim of this review was to create greater awareness and to give an overview of quality assurance in the management of colorectal cancer.
结直肠癌是欧洲最常见的癌症之一。在过去几十年中，结直肠癌的筛查、分期和治疗方面取得了重要进展。然而，欧洲国家之间和内部仍然存在相当大的差异，这意味着进一步改进是可能的。现在最重要的问题是：我们作为医疗保健专业人员，何时为患有结肠癌或直肠癌的患者提供最佳的可用护理？目前，质量保证是结直肠癌护理的一个主要问题，并且在涉及结直肠癌患者治疗的几乎所有学科中，质量保证意识都在发展。质量保证在临床试验中已被证明是有效的。例如，在荷兰 TME 试验中引入了标准化和质量控制，导致直肠癌患者的局部控制和生存率显著提高。此外，审计结构也可以在监测癌症管理方面非常有效，国家审计显示可以进一步改善结直肠癌患者的结果。为了减少欧洲国家之间的差异，发起了一个国际、多学科、基于结果的质量改进计划，即欧洲癌症护理注册（EURECCA）。在不久的将来，EURECCA 数据集将对老年人或合并症患者等亚组进行研究，这些患者通常被排除在试验之外。为了获得最佳的结直肠癌护理，在指南制定和多学科团队管理中进行质量保证也非常重要。本文的目的是提高认识，并概述结直肠癌管理中的质量保证。
