title: Assessing compliance with national comprehensive cancer network guidelines for elderly patients with stage III colon cancer: the Fox Chase Cancer Center Partners' initiative.
abstract: BACKGROUND
  Fox Chase Cancer Center Partners (FCCCP) performs an annual quality review of affiliate practices based on National Comprehensive Cancer Network (NCCN) guidelines. Given recent treatment advances, we initiated this medical record review in elderly patients with stage III colon cancer to measure compliance with these guidelines.
  
  
  METHODS
  Medical records of 124 patients age ≥ 65 diagnosed with stage III colon cancer between 2003 and 2006 were reviewed. Metrics were developed and based on NCCN guidelines for workup and staging, treatment, and gerontology. Documentation was reviewed via paper (13 sites) and electronic record (2 sites).
  
  
  RESULTS
  High compliance with staging and workup guidelines was noted with chest imaging (100%), stage (98%), computed tomography (CT) of the abdomen/pelvis (93%), pathology (91%), and carcinoembryonic antigen (CEA; 91%). Activities of daily living were documented commonly (83%) but colonoscopy less (75%). Age and life expectancy were discussed with the patient in only 49%. Nearly all patients (123 of 124 patients) received adjuvant chemotherapy, with 76 patients (61%) receiving oxaliplatin. Common regimens were FOLFOX (oxaliplatin plus infusional/bolus 5-fluorouracil and folinic acid) 54%, 5-fluorouracil/leucovorin (5-FU/LV; 19%), and capecitabine (12%). Reasons for excluding oxaliplatin were comorbidity (68%), age (19%), and not specified (13%). Three-quarters of the patients had ≥ 12 lymph nodes sampled and 56% identified the radial margin. Nearly all patients (115 = 93%) received surveillance with history and physical and CEA. Surveillance CT was performed in 78% of the patients.
  
  
  CONCLUSIONS
  A quality review of community oncology practices can assess implementation of treatment advances. Guideline compliance for elderly patients with stage III colon cancer is generally high. Forty percent did not receive oxaliplatin and documentation of life expectancy was infrequent. Further study of oncologist decision making for elderly colon cancer patients is warranted.
authors.affiliation: Fox Chase Cancer Center Partners, Rockledge, PA 19046, USA.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: O'Grady
authors.forename: Elyse
authors.initials: E
authors.lastname: Slater
authors.forename: Elin R
authors.initials: ER
authors.lastname: Sigurdson
authors.forename: Neal J
authors.initials: NJ
authors.lastname: Meropol
authors.forename: Alan
authors.initials: A
authors.lastname: Weinstein
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Lusch
authors.forename: Elaine
authors.initials: E
authors.lastname: Sein
authors.forename: Patricia
authors.initials: P
authors.lastname: Keeley
authors.forename: Bonnie
authors.initials: B
authors.lastname: Miller
authors.forename: Paul F
authors.initials: PF
authors.lastname: Engstrom
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Cohen
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D013505:Digestive System Surgical Procedures; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000592:standards*; D009367:Neoplasm Staging
chemical_list: D000970:Antineoplastic Agents