Page 25 - Delaware Medical Journal - March/April 2019

CASE REPORT
TABLE 1. DCR Performance According to CoC CP3R Standard of Care Measures, 2015 and 2016 Cases
Site
Select Measures
CoC Standard/%
DCR 2015 Cases Meeting CoC Standard
DCR 2016 Cases Meeting CoC Standard
Breast
BCSRT - Radiation administered within 1 year of diagnosis for women under age 70 receiving conservative surgery for breast cancer
4.4 / 90%
94.10%
95.80%
Clinical Rationale: There is extensive evidence from randomized clinical trials demonstrating the impact of radiation with breast conservation surgery. It reduces the risk of local recurrence in the breast and may have a small impact on survival.
Breast
MASTRT - Radiation therapy recommended or administered following any mastectomy within 1 year of diagnosis of breast cancer for women >= 4 positive lymph nodes
4.4 / 90%
92.30%
100%
Clinical Rationale: There is consensus that post-mastectomy radiation should be recommended for women with breast cancer and with >=4 positive regional lymph nodes. Numerous studies have shown a significant reduction in locoregional recurrence rates, disease-free survival rates, and even overall survival with this adjuvant therapy.
Colon
12RLN - At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer
4.5 / 85%
95.70%
92.00%
Clinical Rationale: The College of American Pathologists (1999) recommended that a minimum of 12 lymph nodes be examined to accurately identify AJCC stage IIIC colon cancer. The AJCC (5th edition) indicated that it was desirable to obtain at least 12 lymph nodes in radical colon resections (1997). In its 6th edition, the AJCC modified this recommendation to obtain at least 7 to 14 lymph nodes but included rectal resections among the procedures associated with this numeric recommendation. By its 7th edition, citing data from NCI/SEER, the AJCC clearly noted the positive relationship between the number of nodes pathologically examined and patient survival.
Gastric
G15RLN - At least 15 regional lymph nodes are removed and pathologically examined for resected gastric cancer
4.5 / 80%
76.9%*
82.30%
Clinical Rationale: Evidence of improved overall survival outcomes with improved lymphadenectomy.
*Delaware’s cases did not meet the G15RLN standard of care measure for 2015 diagnosis year data. There are many factors that affect the ability to meet this measure, including extent of pathologic dissection of lymph nodes.
Lung
LCT - Chemotherapy administered within 4 months to day preop or day of surgery to 6 months postop, or it is recommended for surgically resected cases with pathologically lymph node positive (pN1) and (pN2) nonsmall cell lung cancer (NSCLC)
4.5 / 85%
100%
100%
Clinical Rationale not provided in CoC measure specifications.
Source: American College of Surgeons CoC Quality of Care Measures, Revised January 30, 2018. www.facs.org/quality-programs/cancer/ncdb/qualitymeasures

the CoC’s CP3R standards. Two of the measures, BCSRT and Mastectomy with Radiation Therapy (MASTRT), address quality of care for breast cancer. The CoC therapy was administered within one year (365 days) of diagnosis for women under age 70 receiving breast-conserving surgery for breast cancer.”4 The clinical rationale for this measure, as described in the measure evidence from randomized clinical trials that radiation therapy reduces the risk of local recurrence in the breast and may have a small impact on survival.”5 MASTRT is recommended or administered following
any mastectomy within one year (365 days) of diagnosis of breast cancer for women 6 The CoC provides the rationale that numerous studies locoregional recurrence rates, disease-free survival rates, and overall survival with radiation as adjuvant therapy for breast 7 The CoC sets the standard-of-care measure at 90% of cases for both of these breast- cancer-care quality metrics.
The 12RLN measure concerns quality
in colon cancer. The CoC criterion for meeting the 12RLN standard is that 85%
or more cases have “at least 12 regional lymph nodes removed and pathologically examined for resected colon cancer.”8 Since
the early 1990s, multiple standard setters have recommended the examination of at least seven to 12 lymph nodes for colon cancer. Using this data, the CoC’s rationale for the quality metric cites the 7th edition AJCC manual, which “clearly notes the positive relationship between the number of nodes pathologically examined and patient 9
The fourth measure observed in this study is the Gastric 15 Regional Lymph Nodes (G15RLN) metric for gastric cancers. The CoC recommends that at least 80% of gastric cancers have “at least 15 regional lymph nodes removed and pathologically examined for resected gastric cancer.” The clinical rationale cited for this measure
is that there is “evidence of improved
Del Med J | March/April 2019 | Vol. 91 | No. 2
73