Elaine Sein

Assessing Compliance with National Comprehensive Cancer Network Guidelines for Elderly Patients with Stage III Colon Cancer: The Fox Chase Cancer Center Partners' Initiative

BACKGROUND Fox Chase Cancer Center Partners (FCCCP) performs an annual quality review of affiliate practices based on National Comprehensive Cancer Network (NCCN) guidelines. Given recent treatment advances, we initiated this medical record review in elderly patients with stage III colon cancer to measure compliance with these guidelines. METHODS Medical records of 124 patients age ≥ 65 diagnosed with stage III colon cancer between 2003 and 2006 were reviewed. Metrics were developed and based on NCCN guidelines for workup and staging, treatment, and gerontology. Documentation was reviewed via paper (13 sites) and electronic record (2 sites). RESULTS High compliance with staging and workup guidelines was noted with chest imaging (100%), stage (98%), computed tomography (CT) of the abdomen/pelvis (93%), pathology (91%), and carcinoembryonic antigen (CEA; 91%). Activities of daily living were documented commonly (83%) but colonoscopy less (75%). Age and life expectancy were discussed with the patient in only 49%. Nearly all patients (123 of 124 patients) received adjuvant chemotherapy, with 76 patients (61%) receiving oxaliplatin. Common regimens were FOLFOX (oxaliplatin plus infusional/bolus 5-fluorouracil and folinic acid) 54%, 5-fluorouracil/leucovorin (5-FU/LV; 19%), and capecitabine (12%). Reasons for excluding oxaliplatin were comorbidity (68%), age (19%), and not specified (13%). Three-quarters of the patients had ≥ 12 lymph nodes sampled and 56% identified the radial margin. Nearly all patients (115 = 93%) received surveillance with history and physical and CEA. Surveillance CT was performed in 78% of the patients. CONCLUSIONS A quality review of community oncology practices can assess implementation of treatment advances. Guideline compliance for elderly patients with stage III colon cancer is generally high. Forty percent did not receive oxaliplatin and documentation of life expectancy was infrequent. Further study of oncologist decision making for elderly colon cancer patients is warranted.

How to establish a high-risk cancer genetics clinic: Limitations and successes

The development of technology to locate and isolate cancer susceptibility genes has brought together the fields of oncology, cancer control, genetics, and genetic counseling to create a new specialty of cancer risk counseling with the goal to communicate more accurate information about personal cancer risk profiles based on personal and family histories. As cancer risk assessment and counseling services become standard of care in medical practice, their availability is increasingly moving from comprehensive cancer centers and academic institutions to community settings. High-risk cancer genetics clinics in the community face several challenges, including staffing, time commitment, costs, and unique quality control issues. The societal benefits include a more educated public armed with the information needed to make health decisions appropriate for the individual level of risk.

Improving Practice One Patient, One Nurse, One Day at a Time: Design and Evaluation of a Quality Education Workshop for Oncology Nurses

High-quality nursing care is not delivered consistently to the millions of Americans treated for invasive cancer in the United States. As part of its quality initiative, the Oncology Nursing Society (ONS) developed and tested nursing-sensitive quality measures for breast cancer care. Findings from the pilot testing suggested significant knowledge and practice gaps that could be addressed through member education.

Measuring the Impact Navigation Has on Patient Care by Supporting the Multidisciplinary Team

As evidence guides practice, it is essential for navigation programs to identify core metrics and standardize data collection in order to clearly demonstrate program outcomes. There is discontinuity in the literature regarding the key areas that measure the success of navigation programs: patient experience (PE), clinical outcomes (CO), and business performance or return on investment (ROI) metrics. The National Quality Forum’s criteria for measure development designed a solid framework with four pillars: important to measure and report, scientifically acceptable, usable/relevant, and feasible to collect. The Academy of Oncology Nurse & Patient Navigators (AONN+) Metrics Task Force developed standard metrics using scientific methodology in the area of PE, CO, and ROI using the AONN+ domains for certification. These domains contain a comprehensive list of all areas navigators practice in order to provide quality patient care and financial stability for their organizations. The 35 developed metrics are baseline metrics that all navigation programs no matter what their structure should be evaluating and monitoring. Navigation programs are developing at different rates within diverse structural organizations and settings, which will determine which standardized metrics will be essential to measure outcomes for their specific navigation program. The metrics align with national standards such as the Commission on Cancer (CoC), National Accreditation Program for Breast Centers (NAPBC), Quality Oncology Practice Initiative (QOPI), and value-based care. National standards help drive continuous quality improvement, value, and identify best practice programs that elevate cancer care on a grander scale. The integration of performance improvement methodologies and data analytics drives quality outcomes and reimbursement.

Prospective quality review of breast care navigation and treatment: Fox Chase Cancer Center Partners’ (FCCCP) initiative.

85 Background: There is increasing emphasis on quality metrics and process improvement for breast cancer treatment. FCCC designed a study to measure compliance with NCCN breast cancer guidelines at 11 FCCCP institutions. METHODS A relational data base was created to track indicators for operational timing, access, treatment modalities, and variance data in a population of breast cancer patients diagnosed and receiving first course of treatment at participating FCCCP institutions for 2009 calendar year. Pilot was conducted to ensure integrity of data collection tool in the previous year. Activation workshop, quarterly on site quality monitoring plan, real time quarterly reports to cancer committee, and benchmarking data were embedded in study. The primary objective was to benchmark participating institutions against each other and national benchmarks. Secondary objectives were to assess causes for variance and explore the role nurse navigation plays in real time quality metrics. RESULTS See Table. CONCLUSIONS This novel prospective quality study demonstrated significant compliance with established breast cancer metrics across a large community hospital affiliate program. The impact of navigation appears greatest in reducing time between screening and diagnostic testing, demonstrating that navigations benefits extend beyond patient satisfaction to improvement of quality metrics. [Table: see text].

Assessing the treatment quality of elderly patients with stage III colon cancer in a large community oncology network: A Fox Chase Cancer Center Partners (FCCCP) quality initiative

6576 Background: FCCCP performs an annual quality review of affiliated community practices based on NCCN guidelines. Given recent treatment advances in stage III colon cancer, we initiated a chart review in patients (pts) age ≥65 years to assess incorporation of these advances in elderly pts. Methods: Charts of 124 pts age ≥65 diagnosed with stage III colon cancer between 2003 and 2006 were reviewed and a relational database used for data capture and report generation. Based on NCCN guidelines, specific metrics were developed for colon cancer, gerontology, and activities of daily living (ADL) documentation, treatment, and surveillance. Documentation was reviewed via paper record in 13 sites and electronic medical record in 2. Results: Compliance with NCCN guidelines for documentation was: staging (98%), pathology report (91%), colonoscopy (75%; 58% reaching cecum), CEA (91%), CT abdomen/pelvis (93%), and chest imaging (100%). ADL were documented commonly (83%), but age and life expectancy in relation to a...