Journal of the National Cancer Institute Advance Access published online on September 9, 2008
JNCI Journal of the National Cancer Institute, doi:10.1093/jnci/djn293
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© The Author 2008. Published by Oxford University Press.
ARTICLES |
Lymph Node Evaluation as a Colon Cancer Quality Measure: A National Hospital Report Card
Affiliations of authors: Cancer Programs, American College of Surgeons, Chicago, IL (KYB, AKS, DPW, TRR, CYK); Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (KYB, DJB, MST, DPW); Department of Surgery, Evanston Northwestern Healthcare, Evanston, IL (MST, DPW); Department of Surgery, University of California, Los Angeles and VA Greater Los Angeles Healthcare System, Los Angeles, CA (CYK)
Correspondence to: Karl Y. Bilimoria, MD, MS, Cancer Programs, American College of Surgeons, 633 North St Clair Street, 25th Floor, Chicago, IL 60611 (e-mail: kbilimoria{at}facs.org).
Background: Examination of 12 or more regional lymph nodes for colon cancer is associated with improved staging and survival, and the National Quality Forum recently endorsed lymph node examination for colon cancer as a quality surveillance measure. However, information regarding the extent of hospital compliance with the 12-node measure in the United States is lacking.
Methods: From the National Cancer Data Base, 1296 hospitals that performed 156 789 colectomies in 1996–1997 and 2004–2005 were identified, and rates of hospital-level compliance (defined as examination of 
12 nodes in 75% of patients) in these two time periods were compared. Multivariable models were developed to determine if hospital type, volume, or differences in case mix were associated with 12-node measure compliance. All statistical tests were two-sided.
Results: In 1996–1997, 15% of hospitals were compliant with the 12-node measure; in 2004–2005 the percentage of compliant hospitals had increased to 38%. From 1996–1997 to 2004–2005, 12-node measure compliance increased at 980 hospitals, remained unchanged at 6 hospitals, and decreased at 310 hospitals. In 2004–2005, National Cancer Institute–designated Comprehensive Cancer Centers were more frequently compliant with the 12-node measure than other academic hospitals, Veterans’ Administration hospitals, or community hospitals (78.1% versus 52.4%, 53.1%, and 33.7%, respectively, all P < .001), even after adjustment for differences in characteristics of the colon cancer patients at these hospitals.
Conclusions: This study provides a national report card of nearly 1300 hospitals showing that more than 60% of institutions failed to achieve a compliance benchmark for the 12-node measure. Considerable improvement is needed in colon cancer nodal evaluation in the United States.
| Context and Caveats Prior knowledge Although examination of 12 or more regional lymph nodes in patients diagnosed with colon cancer is associated with improved survival, the extent to which hospitals comply with the 12-node measure was unknown. Study design Rates of hospital compliance with the 12-node measure (defined as examination of 12 or more nodes in 75% or more of patients) in 1996–1997 and 2004–2005 were determined from the National Cancer Data Base. Logistic regression models were used to determine associations of hospital characteristics with compliance. Contribution Although the percentage of hospitals compliant with the 12-node measure increased over time, only 38% of hospitals were compliant in 2004–2005. National Cancer Institute–designated Comprehensive Cancer Centers and academic hospitals were more likely than community hospitals to be in compliance with the 12-node measure. Implications Improvement is needed in nodal evaluation of colon cancer patients in the United States. Limitations The authors only had access to data from hospitals approved by the Commission on Cancer, which may have biased estimates of compliance at community hospitals. From the Editors
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Manuscript received February 28, 2008; revised June 27, 2008; accepted July 16, 2008.
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Del.icio.us What's this?
J Natl Cancer Inst 2008 100: 1269.
J Natl Cancer Inst 2008 100: 1269.
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