title: Concordance with national guidelines for colorectal cancer care in New South Wales: a population-based patterns of care study.
abstract: OBJECTIVE
  To investigate predictors of evidence-based surgical care in a population-based sample of patients with newly diagnosed colorectal cancer.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: Surgical Outcomes Research Centre (SOuRCe), University of Sydney, Sydney, NSW. jyoung@email.cs.nsw.gov.au
authors: Jane M
authors: JM
authors: Young
authors: David C
authors: DC
authors: Leong
authors: Katie
authors: K
authors: Armstrong
authors: Dianne
authors: D
authors: O'Connell
authors: Bruce K
authors: BK
authors: Armstrong
authors: Allan D
authors: AD
authors: Spigelman
authors: Stephen
authors: S
authors: Ackland
authors: Pierre
authors: P
authors: Chapuis
authors: Andrew B
authors: AB
authors: Kneebone
authors: Michael J
authors: MJ
authors: Solomon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003082:Colectomy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D009517:New South Wales; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010349:Patient Compliance; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant / Q000592:standards; D012307:Risk Factors; D012955:Societies, Medical
chemical_list: D000970:Antineoplastic Agents