CHICAGO -- A quality-control audit of community hospitals associated with Fox Chase Cancer Center in Philadelphia suggests that a partnership between a major academic cancer center, where most new treatment protocols are created, and community hospitals, where most care is provided, is a highly effective model for quickly and effectively disseminating advances in cancer treatment.
Fox Chase, an NCI-designated Comprehensive Cancer Center in Philadelphia, first established its network of 26 select hospitals in 1986. The Fox Chase Cancer Center Partners program is based on a strong foundation of cancer research and education in the community. A strong feature of the program is the access Partner hospitals have to the most advanced cancer treatment guidelines developed by Fox Chase and other member institutions of the National Comprehensive Cancer Network (NCCN).
"When research leads to significant changes in treatment, it can take years before community oncologists are able to fully adopt the new guidelines. What's unique about the Partners program is the timely translation of advances," said Margaret O'Grady, R.N., M.S.N., O.C.N., Director of Care Management and Clinical Operations of Fox Chase Cancer Center Partners. "The audit we conducted shows that our Partner physicians are highly compliant in incorporating recent advances in cancer treatment."
O'Grady and her team reviewed the medical charts of 124 patients at least 65 years or older treated for stage III colon cancer at Partner hospitals between 2003 and 2006. They checked for documentation compliance regarding recent advancements in the treatment of colon cancer according to treatment guidelines published by the NCCN. Specifically, the advances included increased awareness of obtaining a minimum of 12 lymph nodes at surgery, and the addition of oxaliplatin to adjuvant chemotherapy.
Compliance with NCCN guidelines for documentation was high: staging (98 percent), pathology report (91 percent), colonoscopy (75 percent and 58 percent reaching cecum), CEA (91 percent), CT abdomen/pelvis (93 percent), and chest imaging (100 percent). Activities of daily living were documented commonly (83 percent).
Nearly all patients (123/124) received adjuvant chemotherapy, although only 76 (61 percent) received oxaliplatin, a chemotherapeutic shown to extend the survival in this patient population.
"At first glance, this number looked low, but as we probed further, we found that all but 11 patients who didn't receive oxaliplatin had documented co-morbidities or other concerns that precluded them from receiving this treatment," explained O'Grady.
Thus, community medical oncologists were aware of data suggesting benefit of oxaliplatin, and documented reasoning for patients not receiving it. Whether elderly patients with stage III colon cancer are generally being undertreated requires further study.
The most common chemotherapy regimens administered were FOLFOX (54 percent), bolus 5-FU/LV (19 percent), and capecitabine (12 percent).
"Our audit also found a high rate of lymph node retrieval. This is critically important to medical oncology treatment planning," O'Grady said.
The records indicated that 74 percent of the patients had at least 12 lymph nodes retrieved. Nearly all patients (93 percent) received appropriate surveillance with history and physical exams at suggested intervals and routine CEA testing. Abdominal and pelvic surveillance CT was performed in 78 percent of patients.
"We found a drop off in compliance regarding the documentation of discussions between the doctor and patient about age and life expectancy in relation to adjuvant chemotherapy," said O'Grady. "This discussion is important and informs decision making."
Discussions about life expectancy and a patient's age were documented in only 49 percent of the cases.
"Further research should focus on targeted education efforts in these areas and assessment of their impact," O'Grady concluded.