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Title: Concordance with national guidelines for colorectal cancer care in New South Wales: a population-based patterns of care study
Authors: Young JM; Solomon MJ; Leong DC; Armstrong K; O'Connell DL; Armstrong BK; Spigelman AD; Ackland S; Chapuis P; Kneebone AB
Categories: Cancer Control, Survivorship, and Outcomes Research - Health Services, Economic and Health Policy Analyses
Treatment - Systemic Therapies – Clinical Applications
Cancer Type - Bowel & Colorectal Cancer
Keywords: Aged; Design; drug therapy; Female; Guideline Adherence; Guidelines; Hospitals; Humans; Male; Meta-Analysis; methods; Aged,80 and over; Middle Aged; Multicenter Studies; New South Wales; Outcome Assessment (Health Care); Patient Compliance; Patterns of care; Population Surveillance; Practice Guidelines; Prospective Studies; Questionnaires; Antineoplastic Agents; radiotherapy; Radiotherapy,Adjuvant; Registries; Research; Risk Factors; Societies,Medical; standards; surgery; therapeutic use; therapy; cancer; Wales; cancer registry; Colectomy; Colon; colorectal cancer; Colorectal Neoplasms
Year: 2006
Journal Title: Medical Journal of Australia
Volume: 186
Issue: 6
Page number start: 292
Page number end: 295
Abstract: OBJECTIVE: To investigate predictors of evidence-based surgical care in a population-based sample of patients with newly diagnosed colorectal cancer. DESIGN, PATIENTS AND SETTING: Prospective audit of all new patients with colorectal cancer reported to the New South Wales Central Cancer Registry between 1 February 2000 and 31 January 2001. MAIN OUTCOME MEASURES: Concordance with seven guidelines from the 1999 Australian evidence-based guidelines for colorectal cancer; predictors of guideline concordance; the mean proportion of relevant guidelines followed for individual patients. RESULTS: Questionnaires were received for 3095 patients (91.6%). Between 0 and 100% of relevant guidelines were followed for individual patients (median, 67%). Concordance with individual guidelines varied considerably. Patient age independently predicted non-concordance with guidelines for adjuvant therapy and preoperative radiotherapy. Adjuvant chemotherapy was more likely if a patient with node-positive colon cancer was treated in a metropolitan hospital or by a general surgeon. Surgeons with a high caseload or specialty in colorectal cancer were more likely to perform colonic pouch reconstruction, prescribe thromboembolism or antibiotic prophylaxis, and were less likely to refer patients with high-risk rectal cancer for adjuvant radiotherapy. Bowel preparation was less likely among older patients and in high-caseload hospitals. CONCLUSION: Effective strategies to fully implement national colorectal cancer guidelines are needed. In particular, increasing the use of appropriate adjuvant therapy should be a priority, especially among older people
Programme: Health Services Research; Colorectal Cancer
Division: Cancer Research Division
Appears in Collections:Research Articles

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