Pathology examination of 12 or more lymph nodes is associated with improved staging and survival in colon cancer patients, yet just 38 percent of U.S. hospitals were compliant with this guideline in 2004-2005, according to a study published in the September 9 online issue of the Journal of the National Cancer Institute.
In 1997 the American Joint Committee on Cancer recommended that 12 or more lymph nodes be examined in colon cancer patients. Several other oncology organizations have followed suit since then. However, it was not clear how many hospitals followed this guideline, if the percentage of patients who have 12 or more nodes examined increased following the recommendation, or what hospital or patient characteristics were associated with compliance.
To find out, Karl Bilimoria, M.D., of the American College of Surgeons and Northwestern University School of Medicine in Chicago and colleagues examined data from 1,296 hospitals included in the National Cancer Data Base. They identified 74,669 colon cancer patients who underwent colectomy in those hospitals in 1996-1997 and 82,120 in 2004-2005.
In 1996-1997, 15 percent of hospitals were compliant with the recommendation, which required that at least 75 percent of the patients had 12 or more nodes examined. By 2004-2005 that percentage climbed to 38 percent. The frequency of compliance with the 12-node measure increased between 1996-1997 and 2004-2005 in 900 hospitals, remained constant in 6 hospitals, and decreased in 310 hospitals.
The type of hospital was statistically significantly associated with compliance rate. In 2004-2005, physicians examined 12 or more nodes in 78.1 percent of the colon cancer patients in National Cancer Institute–designated Comprehensive Cancer Centers, 52.4 percent in other academic institutions, 53.1 percent in Veterans Administration hospitals, and 33.7 percent in community hospitals.
This is the first time researchers have used the 12-node measure to evaluate quality of colon cancer care in U.S. hospitals, according to the investigators. Although the proportion of compliant hospitals increased since the quality measure was first recommended, "the majority of hospitals failed to comply with the 12-node measure," the authors write.
The current study demonstrates that improved compliance is feasible. "Nodal evaluation is likely to improve further with the recent development of a 12-node measure by multiple national oncology organizations and as physicians and hospitals recognize that a requirement to examine 12 or more nodes may affect referral and reimbursement," the authors write.
Contact: Marla Paul (Northwestern University), marla-paul@northwestern.edu, (312) 503-8928 or Sally Garneski (American College of Surgeons), SGarneski@facs.org
Citation: Bilimoria KY, Bentrem DJ, Stewart AK, Talamonti MS, Winchester DP, Russell TR, Ko CY. Lymph Node Evaluation as a Colon Cancer Quality Measure: A National Hospital Report Card. J Natl Cancer Inst 2008; 100:1310-1317
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