title: Quality measures for the use of adjuvant chemotherapy and radiation therapy in patients with colorectal cancer: a systematic review.
abstract: BACKGROUND
  Chemotherapy (CT) and radiation therapy (RT) are essential components of adjuvant (preoperative or postoperative) therapy for many patients with colorectal cancer (CRC); however, quality measures (QMs) of these critical aspects of CRC treatment have not been characterized well. Therefore, the authors conducted a systematic review of the literature to determine the available QMs for adjuvant CT and RT in patients with CRC and rated their usefulness for assessing the delivery of quality care.
  
  
  METHODS
  The MEDLINE and Cochrane data bases were searched for all publications that contained potential/actual QMs pertaining to adjuvant therapy for CRC. Identified QMs were rated by using criteria developed by the National Quality Forum.
  
  
  RESULTS
  Thirty-two articles met the established inclusion/exclusion criteria. Those 32 articles contained 12 potential or actual QMs, 6 of which had major flaws that limited their applicability. The most useful QMs identified were 1) the percentage of patients with AJCC Stage III colon cancer who received postoperative CT and 2) the percentage of patients with Stage II or III rectal cancer who received chemoradiotherapy.
  
  
  CONCLUSIONS
  To the authors' knowledge, very few QMs pertaining to adjuvant CT or RT for CRC have been published to date, and only half of those measures were rated as useful, acceptable, and valid in the current literature review. Future research should focus on refining existing QMs and on developing new QMs that target important leverage points with respect to the provision of adjuvant therapy for patients with CRC.
authors.affiliation: Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710, USA. robert.prosnitz@duke.edu
authors.forename: Robert G
authors.initials: RG
authors.lastname: Prosnitz
authors.forename: Meenal B
authors.initials: MB
authors.lastname: Patwardhan
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Samsa
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Mantyh
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Fisher
authors.forename: Douglas C
authors.initials: DC
authors.lastname: McCrory
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Cline
authors.forename: Rebecca N
authors.initials: RN
authors.lastname: Gray
authors.forename: Michael A
authors.initials: MA
authors.lastname: Morse
mesh_terms: D017024:Chemotherapy, Adjuvant / Q000592:standards*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy / Q000592:standards; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011182:Postoperative Care / Q000706:statistics & numerical data; D011787:Quality of Health Care; D018714:Radiotherapy, Adjuvant / Q000592:standards* / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data