Concordance with national guidelines for colorectal cancer care in New South Wales: a population-based patterns of care study.
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.
Young
Jane M
JM
Surgical Outcomes Research Centre (SOuRCe), University of Sydney, Sydney, NSW. jyoung@email.cs.nsw.gov.au
Leong
David C
DC
Armstrong
Katie
K
O'Connell
Dianne
D
Armstrong
Bruce K
BK
Spigelman
Allan D
AD
Ackland
Stephen
S
Chapuis
Pierre
P
Kneebone
Andrew B
AB
Solomon
Michael J
MJ
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
D000970:Antineoplastic Agents