In an analysis from the ASCO Quality Oncology Practice Initiative (QOPI) reported in JCO Oncology Practice, Chen et al found that a high proportion of patients with rectal cancer do not receive guideline-recommended pretreatment staging transrectal ultrasound or pelvic magnetic resonance imaging (MRI).
As stated by the investigators, “For patients with nonmetastatic rectal cancer, the National Comprehensive Cancer Network guidelines recommend initial staging using pelvic [MRI] or endorectal ultrasound to determine the stage of the disease before initial therapy or surgery. This imaging workup helps determine the T and N staging, which is essential to determine optimal treatment for a patient.”
The study assessed data on use of guideline-concordant pretreatment imaging from 103 QOPI-participating practices across the United States reporting performance on QOPI measure Colorectal 78 (which addresses staging workup for patients with rectal cancer) across seven time points from Fall 2016 through Fall 2019. In addition, 69 practices that submitted data in 2016 and 2017 were surveyed to analyze potential reasons for nonconcordance.
Across the seven time points, a total of 20 to 33 practices reported data from 1,158 unique patients. Proportions of patients receiving guideline-concordant pretreatment imaging were 38% in Fall 2016, compared with 37% in Spring 2017 (P = .86), 44% in Fall 2017 (P = .38), 39% in Spring 2018 (P = .81), 58% in Fall 2018 (P = .006), 70% in Spring 2019 (P = .004), and 56% in Fall 2019 (P = .014), with an apparent increased adherence to guidelines over time.
In the survey of 69 practices submitting data in 2016 and 2017, the most common reasons for nonconcordance were lack of care coordination between oncology and surgery disciplines (16 of 28 practices = 57.1%) and lack of awareness of appropriate staging scans (8 of 26 practices = 28.6%).
The investigators concluded: “As one half to one third of patients still do not receive appropriate imaging, our findings highlight the need for concerted quality improvement efforts that involve the multidisciplinary team to close this gap.”
Mary May Priscilla Kozlik, BSBA, American Society of Clinical Oncology, is the corresponding author for the JCO Oncology Practice article.
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