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2008 FOCUS STUDY
THE REVEREND ROGER PATRICK
DORCY CANCER CENTER
FOCUS STUDY ON
COLON CANCER USING
SMC AND NCDB DATA
COLON CANCER



ST. MARY-CORWIN REGIONAL MEDICAL
CENTER (SMC)
NATIONAL CANCER DATA BASE (NCDB)
NATIONAL COMPREHENSIVE CANCER
NETWORK (NCCN)
For the year 2007 there were
112, 340 estimated new cases of
colon cancer and 41,420 new cases
of rectal cancer. Combined these two
sites yielded the fourth most frequent
site of cancer behind prostate, lung
and breast as well as the third most
common cause of cancer death.
The Cancer Registry at SMC
validates these statistics, registering
32 cases of colon cancer and 27
cases of rectal cancer out of a total of
709 analytic cases in 2007. Advances
continued in 2007 with progress noted
in screening, surgical pathology and
systemic treatment which have
improved overall survival nationwide.
SMC TOP PRIMARY SITES 2007
St. Mary-Corwin
Top 12 Primary Sites 2007
Num ber
0
20
40
60
80
100
120
118
Prostate
76
Lung
43
H&N/Esophagus
32
Colon
Primary Site
160
148
Breast
30
Lymphoma
29
Bladder
27
Rectum/Rectosigmoid
Thyroid
23
Kidney
23
22
Bone Marrow
Pancreas
140
16
Through grants from the Colorado
Colorectal Screening Program 256
indigent patients were able to be
screened with colonoscopy. Those
diagnosed with colorectal cancer
were then supported through their
surgical management and adjuvant
chemoradiation on site at SMC.
SMC participated in the NCDB e-QUIP
study for colorectal cancer which reviewed
Lymph Node Dissection (LND) rates as
well as use of adjuvant radiation. The
Pathology Department at SMC has taken
a leadership role in developing and
implementing protocols for lymph node
retrieval. Our study was able to document
a 65% (28/43) success rate in examining
at least 12 regional lymph nodes in each
resected specimen. This benchmark has
now become a standard in the NCCN
practice guidelines.
Cancer Program Practice Profile Reports (CP3R):
for Colon Cancers Diagnosed 2004 - 2006
St. Mary-Corwin Medical Center, Pueblo, CO
FACILITY SELECTION
ALL MEASURES EPR
At least 12 regional lymph nodes are removed and pathologically examined for
resected colon cancer. [12RLN]
Performance Rates and Reported
Cases
2004
2005
2006
Total
68.8%
63.2%
62.5%
65.1%
11/16
12/19
5/8
28/43
16
19
8
43
Cases not assessable due to incomplete tumor characteristics [I]
0
0
0
0
Cases not applicable for this measure by definition [NA]
0
0
0
0
24
20
14
58
40
39
22
101
Estimated Performance Rates
Performance Rate Numerator / Denominator
Cases eligible for the measure (Denominator) [Comp]
Cases not eligible for consideration for any colon measure [NE]
Total number of colon cancer cases reported to
NCDB
Interpreting this table: The estimated performance rates shown in this table provides your cancer program with an indication of the
proportion of patients undergoing colon resection that had an adequate lymph node examination. These rates are computed based on data
directly reported from your registry to the NCDB using specifications endorsed by the NQF.
The CP3R provides cancer programs with the opportunity to examine data to determine if these performance rates are representative of the
care provided at the institution. This application provides the ability to review and modify cases using this application, simply click on the cell of
underlined cases of interest to view a detailed case listing.
Displayed performance rates are immediately updated once modifications via the CP3R are completed by cancer program staff. Note: Any
modifications made online should be reflected at the local cancer registry, and cancer programs are encouraged to resubmit data to the NCDB.
This page and all contents are Copyright © 2008
by the NCDB and American College of Surgeons, Chicago, IL 60611-3211
Comparison of SMC and Colorado, percentage of
patients having 12 or more lymph nodes removed at
time of surgery for Colon Cancer
Comparison of SMC and Colorado, percentage of patients having 12 or more lymph nodes removed at time of
surgery for colon cancer.
120%
7 pts
100%
100%
15
pts
80%
15 pts
18
pts
80%
Percentage
72%
12
pts
67%
70%
63%
SMC
60%
51%
54%
51%
49%
42%
41%
40%
20%
0%
2003
2004
2005
2006
Years and Total
2007
TOTAL
COLORADO
Percentage of Patients with 12 or more Lymph Nodes Removed
During Surgery for Colon Cancer using all NCDB Data
PERCENTAGE OF PATIENTS WITH 12 OR MORE LYMPH NODES REMOVED DURING SURGERY FOR
COLON CANCER, USING ALL NCDB DATA
80.00%
16
PTS
19
PTS
70.00%
8 PTS
PERCENTAGE
60.00%
50.00%
SMC
40.00%
COLORADO NCDB
NCDB
30.00%
20.00%
10.00%
0.00%
2004
2005
YEAR
2006
The average colorectal patient at SMC
is diagnosed in their eighth decade (age
70-79) which is approximately 3-5%
older than state and national trends.
There is a higher prevalence in
Colorado State registries for female
diagnoses over male with a smaller
trend at SMC. Whether this reflects a
reluctance on the part of males to
undergo screening or a true gender
difference may be a subject for future
study
AGE OF COLON CANCER PATIENTS DIAGNOSED
2000-2005 SMC, NCDB, COLORADO
Age of Colon Cancer Diagnosed 2000-2005 SMC, NCDB, COLO
35%
30%
Percentage
25%
20%
SMC
NCDB
COLO
15%
10%
5%
0%
<40
40-49
50-59
60-69
Age
70-79
80-89
90>
GENDER OF COLON CANCER DIAGNOSED 20002005 SMC, NCDB, COLORADO
Gender of Colon Cancer Diagnosed 2000-2005 SMC, NCDB, COLO
53%
52%
51%
Percentage
50%
49%
SMC
NCDB
COLO
48%
47%
46%
45%
44%
MALE
FEMALE
Gender
Nearly 65% of all patients undergo
surgical resection for colorectal
cancer with about 20% receiving
chemotherapy according to registry
data. These numbers correlate
closely with state and national
registries. At SMC a variation was
seen in stage distribution with a
migration from Stage III to later
Stage IV.
TREATMENT OF COLON CANCER DIAGNOSED
2000-2005 SMC, NCDB, COLORADO
Treatment of Colon Cancer Diagnosed 2000- 2005 SMC, NCDB, COLORADO
80%
70%
60%
Percentage
50%
SMC
40%
NCDB
COLO
30%
20%
10%
0%
Surg only
Surg/Chemo
Other
Treatment
None
STAGE OF COLON CANCER DIAGNOSED 2000-2005
SMC, NCDB, COLORADO
Stage of Colon Cancer diagnosed 2000-2005 SMC, NCDB, COLO
30%
25%
Percentage
20%
SMC
15%
NCDB
COLO
10%
5%
0%
0
I
II
III
Stage
IV
UNK
This delay in diagnosis along with
higher age and comorbidity factors
yielded lower survival seen mostly
in Stage II. These trends will be
subject to closer review.
OBSERVED SURVIVAL FOR STAGE I COLON
CANCER 1998-2000 FOR NCDB AND COLORADO,
1995-2000 FOR SMC
OBSERVED SURVIVAL FOR STAGE I COLON CANCER 1998-2000 FOR NCDB AND COLORADO, 1995-2000
FOR SMC
120%
CUMULATIVE SURVIVAL RATE
100%
80%
SMC N=40
NCDB
60%
COLO
SMC
40%
20%
0%
AT DX
1
2
3
YEARS AFTER DIAGNOSIS
4
5
OBSERVED SURVIVAL FOR STAGE II COLON
CANCER 1998-2000 FOR NCDB AND COLORADO,
1995-2000 FOR SMC
OBSERVED SURVIVAL FOR STAGE II COLON CANCER 1998-2000 FOR NCDB AND COLORADO, 1995-2000
FOR SMC
120%
CUMULATIVE SURVIVAL RATE
100%
80%
SMC N=102
NCDB
60%
COLO
SMC
40%
20%
0%
AT DX
1
2
3
YEARS AFTER DIAGNOSIS
4
5
OBSERVED SURVIVAL FOR STAGE III COLON
CANCER 1998-2000 FOR NCDB AND COLORADO,
1995-2000 FOR SMC
OBSERVED SURVIVAL FOR STAGE III COLON CANCER 1998-2000 FOR NCDB AND COLORADO, 1995-2000
FOR SMC
120%
CUMULATIVE SURVIVAL RATE
100%
80%
NCDB
COLO
60%
SMC
SMC N=58
40%
20%
0%
AT DX
1
2
3
YEARS AFTER DIAGNOSIS
4
5
OBSERVED SURVIVAL FOR STAGE IV COLON
CANCER 1998-2000 FOR NCDB AND COLORADO,
1995-2000 FOR SMC
OBSERVED SURVIVAL FOR STAGE IV COLON CANCER 1998-2000 FOR NCDB AND COLORADO, 1995-2000
FOR SMC
120%
CUMULATIVE SURVIVAL RATE
100%
80%
NCDB
60%
COLO
SMC
40%
20%
SMC N=45
0%
AT DX
1
2
3
YEARS AFTER DIAGNOSIS
4
5
Also seen was lower use of
chemotherapy in Stage III which
may reflect the rural nature of our
region with some added barriers to
treatment.
TREATMENT OF STAGE III COLON CANCER 20002005 SMC, NCDB, COLORADO
TREATMENT OF STAGE III COLON CANCER 2000-2005, SMC, NCDB, COLORADO
60%
50%
PERCENT
40%
SMC
30%
NCDB
COLORADO
20%
10%
0%
SURG ONLY
SURG/CHEMO
TREATMENT
OTHER
SMC remains committed to
excellence in the management of
cancer diagnoses and treatment.
Under the guidance of it’s
multispecialty cancer committee.
These and other trends will be
reviewed and targeted for scrutiny
and improvement.
Vaughan R. Cipperly, MD
Cancer Committee Chairman