Evidence supporting the indicators considered by the expert panel
| Indicator | Source of evidence | |||||
|---|---|---|---|---|---|---|
| Proposed by panel | Case/cohort study | Review | Guideline | NHS | RAND | |
| Prioritized by the panel | ||||||
| Proportion of colon and rectal carcinomas detected by screening | • | |||||
| 5-yr and adjusted 5-yr overall survival rate | x | |||||
| Proportion of in-hospital mortality or mortality within 30 d of colon or rectal cancer surgery (10)– (12) | 1 | 2 | x | |||
| Rate of local recurrence for patients who have had colon or rectal cancer surgery (11), (13) | 2 | |||||
| Proportion of patients undergoing surgery for colon or rectal cancer who have preoperative complete large-bowel imaging (colonoscopy or barium enema plus sigmoidoscopy) 3 mo before surgery or within 6 mo after surgery (11), (14)– (18), (22) | 1 | 6 | x | x | ||
| Proportion of patients undergoing surgery for rectal cancer who have preoperative imaging of the pelvis with CT or MRI (14)– (18) | 5 | |||||
| Proportion of patients undergoing surgery for colon or rectal cancer who have preoperative imaging of the liver with ultrasonography, CT or MRI (14)– (16) | 3 | |||||
| Proportion of patients undergoing surgery for rectal cancer who experience an anastomotic leak (10)– (12), (19) | 1 | 3 | ||||
| Proportion of patients with rectal cancer undergoing surgery with a distal tumour-free margin (microscopic and 1 cm) (11), (12), (20) | 3 | |||||
| Proportion of patients who have undergone rectal cancer surgery whose operative report includes mention of total mesorectal type dissection, location of tumour, extent of resection (en bloc removal and margins) degree of nerve preservation, extent of lymphadenectomy (21) | 1 | |||||
| Proportion of patients with rectal cancer who see a radiation oncologist preoperatively, or whose cancer is stage II or III who see a radiation oncologist within 8 wk of surgery (11), (16), (17), (25)– (28) | 3 | 4 | x | |||
| Proportion of patients with rectal cancer who see a medical oncologist preoperatively, or whose cancer is stage II or III who see a medical oncologist within 8 wk of surgery (11), (16), (17), (25)– (27) | 2 | 4 | x | |||
| Proportion of patients who have undergone colon or rectal cancer surgery whose pathology report includes details on margin status (distal, radial) (13), (21), (30), (31) | 3 | 1 | ||||
| Proportion of patients who have undergone colon or rectal cancer surgery whose pathology report indicates number of lymph nodes examined and the number of positive lymph nodes (13), (21), (30), (31) | 3 | 1 | ||||
| Proportion of patients with colon cancer who undergo surveillance colonoscopy within 1 yr after surgery (11), (17), (22), (23) | 3 | 1 | ||||
| Not prioritized by the panel | ||||||
| Proportion of colorectal cancer referrals seen by 1, 2, 3 wk, etc. | • | |||||
| Proportion of patients with colon cancer admitted for surgery by 1, 2, 3 wk, etc., from time of first surgical consultation | x | x | ||||
| Proportion of patients with rectal cancer admitted for surgery by 1, 2, 3 wk, etc., from time of first surgical consultation and no use of preoperative chemotherapy or radiotherapy | x | x | ||||
| Proportion of patients with colon or rectal cancer undergoing major surgery (by region) | x | |||||
| Proportion of patients with colon or rectal cancer undergoing major curative surgery (by region) | x | |||||
| Proportion of patients undergoing colon or rectal cancer surgery readmitted to hospital within 28 d after discharge | x | |||||
| 5-yr and adjusted 5-yr disease-free survival rate | x | |||||
| Length of survival after recurrence for patients who have had colon and rectal cancer surgery, by disease stage | • | |||||
| Proportion of patients in active follow-up undergoing attempted curative resection for recurrent colon or rectal cancer (11), (29) | 2 | x | ||||
| Not prioritized by the panel | ||||||
| Death rates from malignant neoplasm of the colon and rectum per 100 000 adult population, by region | x | |||||
| Proportion of patients undergoing colon or rectal cancer surgery accrued to colorectal clinical trials | x | |||||
| Proportion of hospitals in a region treating patients with colorectal cancer demonstrating evidence of organized systems for measuring patient satisfaction annually | x | |||||
| Proportion of patients with colon or rectal cancer confirmed by preoperative biopsy | x | |||||
| Proportion of patients undergoing colon or rectal cancer surgery who have preoperative chest radiographs (14)– (18) | 5 | |||||
| Proportion of patients undergoing colon or rectal cancer surgery who have diagnostic workup completed within the 3 mo preceding surgery or 5 mo if neoadjuvant therapy was used | x | x | ||||
| Proportion of patients undergoing surgery for colon or rectal cancer who receive an information package (18) | 1 | |||||
| Average length of stay for patients undergoing colon or rectal cancer surgery (11) | 1 | x | ||||
| Proportion of patients with rectal cancer undergoing sphincter-saving resection (11) | 1 | |||||
| Proportion of patients having undergone colon or rectal cancer surgery who experience an unplanned return to the operating room (19) | 1 | |||||
| Proportion of patients with stage III colon cancer who see a medical oncologist within 8 wk of surgery (24) | 1 | x | ||||
| Proportion of patients with stage II or III rectal cancer who did not receive preoperative radiotherapy who receive radiotherapy within 3 mo after surgery (25), (26) | x | |||||
| Proportion of patients with stage II or III rectal cancer who did not receive preoperative radiotherapy who receive chemotherapy within 2 mo after surgery (25), (26) | 1 | x | ||||
| Proportion of patients with stage III colon cancer who receive chemotherapy within 2 mo after surgery (24) | 1 | |||||
| Proportion of patients having undergone colon or rectal cancer surgery whose pathology report includes T stage (30) | 1 | |||||
| Proportion of patients having undergone colon or rectal cancer surgery whose pathology report includes N stage (13), (21), (30), (31) | 3 | 1 | ||||
| Proportion of patients having undergone colon or rectal cancer surgery whose pathology report includes M stage (30) | 1 | |||||
| Proportion of institutions that use synoptic pathology reporting (31) | 1 | |||||
| Proportion of patients who have undergone surgery for colon cancer or rectal cancer having imaging of the liver with ultrasonography, CT or MRI 6–18 mo after surgery (23), (24), (32) | 1 | 2 | ||||
| Proportion of patients who have undergone surgery for colon cancer or rectal cancer having radiographs, CT or MRI of the chest 6–18 mo after surgery (11), (24) | 1 | 1 | ||||
| Proportion of patients who have undergone surgery for rectal cancer having imaging of the pelvis with CT or MRI 6–18 mo after surgery (23) | 1 | |||||
Note: CT = computed tomography; MRI = magnetic resonance imaging; NHS = National Health Service; RAND = RAND corporation.
• = indicator proposed by the panel and not extracted from the medical literature; x = indicators included amongst those developed by other indicator initiatives; numbers = the number of individual publications in which corresponding indicators were mentioned.