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Donnelly C, Or M, Toh J, Thevaraja M, Janssen A, Shaw T, Pathma-Nathan N, Harnett P, Chiew KL, Vinod S, Sundaresan P. Measurement that matters: A systematic review and modified Delphi of multidisciplinary colorectal cancer quality indicators. Asia Pac J Clin Oncol 2024; 20:259-274. [PMID: 36726222 DOI: 10.1111/ajco.13917] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/19/2022] [Accepted: 12/26/2022] [Indexed: 02/03/2023]
Abstract
AIM To develop a priority set of quality indicators (QIs) for use by colorectal cancer (CRC) multidisciplinary teams (MDTs). METHODS The review search strategy was executed in four databases from 2009-August 2019. Two reviewers screened abstracts/manuscripts. Candidate QIs and characteristics were extracted using a tailored abstraction tool and assessed for scientific soundness. To prioritize candidate indicators, a modified Delphi consensus process was conducted. Consensus was sought over two rounds; (1) multidisciplinary expert workshops to identify relevance to Australian CRC MDTs, and (2) an online survey to prioritize QIs by clinical importance. RESULTS A total of 93 unique QIs were extracted from 118 studies and categorized into domains of care within the CRC patient pathway. Approximately half the QIs involved more than one discipline (52.7%). One-third of QIs related to surgery of primary CRC (31.2%). QIs on supportive care (6%) and neoadjuvant therapy (6%) were limited. In the Delphi Round 1, workshop participants (n = 12) assessed 93 QIs and produced consensus on retaining 49 QIs including six new QIs. In Round 2, survey participants (n = 44) rated QIs and prioritized a final 26 QIs across all domains of care and disciplines with a concordance level > 80%. Participants represented all MDT disciplines, predominantly surgical (32%), radiation (23%) and medical (20%) oncology, and nursing (18%), across six Australian states, with an even spread of experience level. CONCLUSION This study identified a large number of existing CRC QIs and prioritized the most clinically relevant QIs for use by Australian MDTs to measure and monitor their performance.
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Affiliation(s)
- Candice Donnelly
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Michelle Or
- Radiation Oncology Network, Western Sydney Local Health District, Westmead, Australia
| | - James Toh
- Department of Surgery, Westmead Hospital, Westmead, Australia
- Westmead Clinical School, University of Sydney, Sydney, Australia
| | | | - Anna Janssen
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | | | - Paul Harnett
- Westmead Clinical School, University of Sydney, Sydney, Australia
- Crown Princess Mary Cancer Centre, Western Sydney Local Health District, Westmead, Australia
| | - Kim-Lin Chiew
- Ingham Institute for Applied Medical Research, Liverpool, Australia
- Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, Australia
- South Western Clinical School, University of New South Wales, Randwick, Australia
- Princess Alexandra Hospital, Division of Cancer Services, Brisbane, Australia
| | - Shalini Vinod
- Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, Australia
- South Western Clinical School, University of New South Wales, Randwick, Australia
| | - Puma Sundaresan
- Radiation Oncology Network, Western Sydney Local Health District, Westmead, Australia
- Westmead Clinical School, University of Sydney, Sydney, Australia
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Rajaguru V, Jang J, Kwon JA, Kim JH, Shin J, Chun M. A scoping review on population-centered indicators for cancer care continuum. Front Public Health 2022; 10:912946. [PMID: 36311597 PMCID: PMC9614426 DOI: 10.3389/fpubh.2022.912946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/22/2022] [Indexed: 01/22/2023] Open
Abstract
Purpose The purpose of this study was to develop prioritized cancer indicators and measure the population-based monitoring of the entire life cycle of cancer care, guiding the improvement of care delivery systems. Methods Scoping review was performed based on the Joanna Briggs Institute's methodology. Electronic databases were searched in PubMed, Cochrane Library, EMBASE, Ovid Medline, RISS, KISS, and KoreaMed. The searches were limited to articles published in English between 2010 and 2020. No restrictions were applied regarding the publication status or country of origin, and all study designs were included. Gray literature was used to broaden the search's scope, identify new recommendations, need to be in connect with subject experts, and explore pertinent websites. The process and selected indicators were analyzed based on their frequency distribution and percentage. Results The literature search yielded 6,202 works. In addition, national and international cancer guidelines were obtained from official database reports. A total of 35 articles and 20 reports regarding cancer indicators were finally selected for data synthesis. Based on them, 254 core sets of cancer indicators were identified. The selected indicators were classified into six domains based on the continuum of cancer care and survivor's life cycle, namely, primary prevention (61, 24.0%), secondary prevention (46, 18.1%), treatment (85, 33.5%), quality of care (33, 13.0%), survivor management (33, 13.0%), and end-of-life care (14, 5.5%). Conclusion There is a growing interest in developing specific areas of cancer care. Cancer indicators can help organizations, care providers, and patients strive for optimal care outcomes. The identified indicators could guide future innovations by identifying weaknesses in cancer prevention and management.
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Affiliation(s)
- Vasuki Rajaguru
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Jieun Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea,Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, United States
| | - Jeoung A. Kwon
- Institute of Health Services Research, Yonsei University, Seoul, South Korea
| | - Jae Hyun Kim
- Department of Health Administration, Dankook University, Cheonan, South Korea
| | - Jaeyong Shin
- Institute of Health Services Research, Yonsei University, Seoul, South Korea,Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, South Korea,*Correspondence: Jaeyong Shin
| | - Mison Chun
- Department of Radiation Oncology, School of Medicine, Ajou University, Suwon, South Korea,Mison Chun
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Development of Population-Based Cancer Indicators and a Measurement of Cancer Care Continuum Using a Modified Delphi Method. Cancers (Basel) 2021; 13:cancers13194826. [PMID: 34638310 PMCID: PMC8508364 DOI: 10.3390/cancers13194826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 12/09/2022] Open
Abstract
Simple Summary This study intended to identify the current state of national cancer management and prevention policies and provide a useful framework for policy establishment. The development of population-based cancer indicators project was conducted as part of a Nationwide Population-based Cancer Registration Project and aimed to applying quality of health care system approaches to the cancer care in population-based monitoring system. The literature review and grey literature review were conducted prior to Delphi method. Our findings confirm 26 cancer indicators and classify them into “Primary prevention,” “Secondary prevention,” “Treatment,” “Quality of care,” “Survivor management,” and “End-of-life care.” The Donabedian model used for health services and the Institute of Medicine quality of healthcare domains of six dimensions were applied to the measurement system. The developed cancer indicators and measurements will be able to provide useful information for prioritizing the operational tasks that can be used by health authorities and policymakers from the other countries. Abstract To identify population-based cancer indicators and construct monitoring systems for the entire lifecycle of cancer patients using a modified Delphi method. A modified Delphi method was used to identify the cancer indicators and measurement by scoping review and gray literature. The final list of cancer indicators was developed by consensus of 11 multidisciplinary experts over multiple rounds and rating scored the importance of each indicator on a 10-point scale. Frequency analysis was performed to rate with median scores ≥7 and finalized the list of indicators according to the priority. Initially, 254 indicators were identified, of which 94 were considered important and feasible. After two rounds of rating by the experts and panel discussions, 26 indicators were finalized in six domains: primary prevention (n = 7), secondary prevention (n = 11), treatment (n = 2), quality of life (n = 4), survivor management (n = 1), and end-of-life care (n = 1). The Donabedian model used for examining health services and the Institute of Medicine quality of healthcare domains were applied to the measurement system. Panel experts identified cancer indicators based on priorities with a high level of consensus, providing a scrupulous foundation for community-based monitoring of cancer patients.
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Ferko A, Orhalmi J, Dusek T, Chobola M, Hovorkova E, Nikolov DH. Higher risk of incomplete mesorectal excision and positive circumferential margin in low rectal cancer regardless of surgical technique. Wideochir Inne Tech Maloinwazyjne 2014; 9:569-77. [PMID: 25561995 PMCID: PMC4280422 DOI: 10.5114/wiitm.2014.45733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 03/24/2014] [Accepted: 09/14/2014] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Currently, the predominant question is whether a laparoscopic approach is comparatively radical in comparison with an open access approach, especially in the circumferential resection margin and quality of the completeness of total mesorectal excision. These factors are important in determining the quality of surgical care as well as long-term results of the treatment. AIM This article focuses on the evaluation of circumferential resection margins and on the quality of mesorectal excision of middle and lower rectum tumors. In addition, laparoscopic and open techniques are compared. MATERIAL AND METHODS Data were collected prospectively and stored in a rectal cancer registry over a 3-year period. The parameters studied were age, sex, body mass index, localization and topography of the tumor, clinical stage, neoadjuvant chemotherapy and its response, the type of surgery, character of the circumferential and distal margins, quality of the mesorectal excision, pT and pN. RESULTS One hundred and twenty-five patients were chosen for our study. Laparoscopy was performed in 53 operations and a conventional approach was performed in 72 operations. Complete mesorectal excision was achieved in 54.7% of laparoscopic operations versus 44.4% in the conventional technique; partially complete excision was performed in 20.8 and 12.5%, respectively. Incomplete excisions were described in 24.5 and 43.1% (p = 0.085). Positive circumferential margin occurred during laparoscopic surgery in 11 (20.8%) patients, and in the case of conventional resection in 27 (37.5%) patients (p = 0.044). CONCLUSIONS Our study showed comparable results between laparoscopic and open access procedures during rectal resection. The results achieved, in particular in the quality of the mesorectal excision and negative circumferential resection margin, show that the laparoscopic approach is comparable to conventional surgical techniques, with an adequate surgical outcome, in the treatment of rectal cancer.
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Affiliation(s)
- Alexander Ferko
- Department of Surgery, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine, Hradec Kralove, Czech Republic
| | - Julius Orhalmi
- Department of Surgery, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine, Hradec Kralove, Czech Republic
| | - Tomas Dusek
- Department of Surgery, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine, Hradec Kralove, Czech Republic
- Department of Military Surgery, Faculty of Military Health Sciences, University of Defense, Hradec Kralove, Czech Republic
| | - Milan Chobola
- Department of Surgery, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine, Hradec Kralove, Czech Republic
| | - Eva Hovorkova
- The Fingerland Department of Pathology, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine, Hradec Kralove, Czech Republic
| | - Dimitar Hadzi Nikolov
- The Fingerland Department of Pathology, University Hospital Hradec Kralove, Charles University in Prague, Faculty of Medicine, Hradec Kralove, Czech Republic
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Chow CFK, Kim SH. Laparoscopic complete mesocolic excision: West meets East. World J Gastroenterol 2014; 20:14301-14307. [PMID: 25339817 PMCID: PMC4202359 DOI: 10.3748/wjg.v20.i39.14301] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 04/07/2014] [Accepted: 06/13/2014] [Indexed: 02/07/2023] Open
Abstract
Complete mesocolic excision is a relatively new concept in western literature. It follows the same concept of total mesorectal excision and units’ routinely performing complete mesocolic excisions have good pathological results as well as good improvements in overall survival, disease free survival and local recurrence. And yet unlike total mesorectal excision, uptake in the West has been relatively slow with many units sceptical of the true benefits gained by taking up a more technically challenging and potentially more morbid procedure when there is a paucity of literature to support these claims. This article reviews complete mesocolic excision for colon cancer, attempting to identify the risks and benefits of the technique and particularly looking at the reasons why its uptake has not been universal. It also discusses the similarities of a complete mesocolic excision to a colon resection with a D3 lymphadenectomy as well as the role of a laparoscopic approach to this technique. Considering a D3 lymphadenectomy has been the standard of care for stage II and III colon cancers in many of our Asian neighbours for over 20 years, combining this data with data on complete mesocolic excision may provide enough evidence to support or refute the need for complete mesocolic excisions. Maybe there might be lessons to be learnt from our colleagues in the east.
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Damen N, Spilsbury K, Levitt M, Makin G, Salama P, Tan P, Penter C, Platell C. Anastomotic leaks in colorectal surgery. ANZ J Surg 2014; 84:763-8. [PMID: 24456182 DOI: 10.1111/ans.12494] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anastomotic leaks are a serious complication of bowel surgery. This study aimed to evaluate the rate and severity, and identify risk factors for leaks in patients undergoing bowel anastomoses. METHODS Prospective evaluation was performed on patients undergoing bowel surgery within a colorectal surgical unit. Anastomotic leak was defined and graded according to severity. A nurse independently collected the information. Stepwise logistic regression analysis was performed. RESULTS Two thousand three hundred and sixty-three patients underwent 2994 anastomoses. Their median age was 64 years. Seven per cent were emergency operations. Anastomotic leak occurred in 82 patients (2.7%). Sixty-three per cent of leaks were managed with drainage or re-operation. Ultra-low anterior resection (ULAR) was associated with the highest subgroup leak rate (7.3%). In multivariable analysis, independent predictors for a leak included 'other' pathologies (iatrogenic injury, ischaemia, radiation enteritis) (P=0.016, odds ratio (OR): 6.3, 95% confidence interval (CI): 1.4-28.0), ULAR (P=0.001, OR: 8.5, 95% CI: 2.3-31.2) and the surgeon (A: P<0.001, OR: 3.4, 95% CI: 2.1-5.6). CONCLUSION Majority of predictors for anastomotic leak were fairly intuitive. Nonetheless, it was relevant to note the importance of the individual surgeon as an independent predictor for leaks.
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Affiliation(s)
- Nikki Damen
- Colorectal Surgical Unit, St John of God Hospital Subiaco, Perth, Western Australia, Australia
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Bianchi V, Spitale A, Ortelli L, Mazzucchelli L, Bordoni A. Quality indicators of clinical cancer care (QC3) in colorectal cancer. BMJ Open 2013; 3:bmjopen-2013-002818. [PMID: 23869102 PMCID: PMC3717445 DOI: 10.1136/bmjopen-2013-002818] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Assessing the quality of cancer care (QoCC) has become increasingly important to providers, regulators and purchasers of care worldwide. The aim of this study was to develop evidence-based quality indicators (QIs) for colorectal cancer (CRC) to be applied in a population-based setting. DESIGN A comprehensive evidence-based literature search was performed to identify the initial list of QIs, which were then selected and developed using a two-step-modified Delphi process involving two multidisciplinary expert panels with expertise in CRC care, quality of care and epidemiology. SETTING The QIs of the clinical cancer care (QC3) population-based project, which involves all the public and private hospitals and clinics present on the territory of Canton Ticino (South Switzerland). PARTICIPANTS Ticino Cancer Registry, The Colorectal Cancer Working Group (CRC-WG) and the external academic Advisory Board (AB). MAIN OUTCOME MEASURES Set of QIs which encompass the whole diagnostic-treatment process of CRC. RESULTS Of the 149 QIs that emerged from 181 sources of literature, 104 were selected during the in-person meeting of CRC-WG. During the Delphi process, CRC-WG shortened the list to 89 QI. AB finally validated 27 QIs according to the phase of care: diagnosis (N=6), pathology (N=3), treatment (N=16) and outcome (N=2). CONCLUSIONS Using the validated Delphi methodology, including a literature review of the evidence and integration of expert opinions from local clinicians and international experts, we were able to develop a list of QIs to assess QoCC for CRC. This will hopefully guarantee feasibility of data retrieval, as well as acceptance and translation of QIs into the daily clinical practice to improve QoCC. Moreover, evidence-based selected QIs allow one to assess immediate changes and improvements in the diagnostic-therapeutic process that could be translated into a short-term benefit for patients with a possible gain both in overall and disease-free survival.
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Affiliation(s)
- Valentina Bianchi
- Cantonal Institute of Pathology, Ticino Cancer Registry, Locarno, Switzerland
| | - Alessandra Spitale
- Cantonal Institute of Pathology, Ticino Cancer Registry, Locarno, Switzerland
| | - Laura Ortelli
- Cantonal Institute of Pathology, Ticino Cancer Registry, Locarno, Switzerland
| | - Luca Mazzucchelli
- Cantonal Institute of Pathology, Clinical Pathology, Locarno, Switzerland
| | - Andrea Bordoni
- Cantonal Institute of Pathology, Ticino Cancer Registry, Locarno, Switzerland
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Ziv Y, Zbar A, Bar-Shavit Y, Igov I. Low anterior resection syndrome (LARS): cause and effect and reconstructive considerations. Tech Coloproctol 2012; 17:151-62. [PMID: 23076289 DOI: 10.1007/s10151-012-0909-3] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 09/20/2012] [Indexed: 02/06/2023]
Abstract
Between 25 and 80% of patients undergoing a low or very low anterior resection will suffer postoperatively, from a constellation of symptoms including fecal urgency, frequent bowel movements, bowel fragmentation and incontinence, collectively referred to as the low anterior resection syndrome (LARS). The etiology of LARS is multifactorial with the potential of sphincter injury during anastomosis construction, alterations in anorectal physiology, the development of a pudendal neuropathy, and a lumbar plexopathy with exacerbation of symptoms if there is associated anastomotic sepsis or the use of adjuvant and neoadjuavnt therapies. The symptoms of LARS may be obviated in part by the construction of a neorectal reservoir which may take the form of a colonic J-pouch, a transverse coloplasty, or a side-to-end anastomosis. This review outlines the factors contributing to LARS symptomatology along with the short- and medium-term functional results of comparative trials with the different types of neorectal reconstructions.
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Affiliation(s)
- Y Ziv
- Department of General Surgery B, Assaf Harofeh Medical Center, Zerifin, Israel.
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