Patient Safety

PV QA 3 - Poster Viewing Q&A 3

TU_28_3091 - Integration of Ongoing Quality Assurance Measures in Colorectal Cancer Survivorship Care Plans

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Integration of Ongoing Quality Assurance Measures in Colorectal Cancer Survivorship Care Plans
S. Sigurdson1,2, J. Biagi1,2, H. Langley2, K. Kennedy2, and A. Mahmud1,3; 1Queen's University, Kingston, ON, Canada, 2Cancer Centre of Southeastern Ontario, Kingston, ON, Canada, 3Department of Radiation Oncology, Kingston Health Sciences Centre, Kingston, ON, Canada

Purpose/Objective(s): A follow up program for patients with stages II or III colorectal cancer after treatment completion was initiated in 2014 at our institution. Stable patients, with no disease or treatment related issues and not participating in a clinical trial, were discharged to their primary care providers (PCP). A discharge letter, surveillance protocol, and a receipt of information sheet (RIS) were sent to PCP. An institutional quality assurance (QA) measure was started to monitor the return of the RIS. This study was conducted to assess if surveillance was completed according to the guidelines. The hypothesis is that the proportion of patients completing colorectal cancer surveillance tests is similar between patients discharged to their primary care provider and patients who continue follow up at the cancer centre.

Materials/Methods: Research ethics board approval was obtained and 282 patients were identified as new referrals to our institution between April 1, 2014 and June 30, 2016 with stage II or III colorectal cancer. After a chart review 125 were excluded; reasons included treatment elsewhere, repeat charts, developing recurrent or metastatic disease, patient’s refusal or death. In this cohort 157 patients were identified as eligible for discharge to their PCP. In addition 64 patients were identified from the department QA process listing. These patients completed treatment prior to April 2014 but had a discharge according to the new protocol. A total of 221 patients were included in this study who were either eligible for a discharge or were discharged to PCP. The dates of 1 year follow up endoscopy from date of original cancer surgery, computed tomography (CT) scans, and Carcinoembryonic Antigen (CEA) tests were determined after a chart review.

Results: Overall, 83.3% of eligible patients were discharged to their PCP, and by December 31, 2017, 99.0% had completed follow up endoscopy, 84.1% CT scan, and 63.2% CEA tests. Our study identified 59 additional patients discharged to their PCP who were not included in the list of patients obtained from the department QA process. There was some variation in practice where one oncologist preferred continuing follow up at the cancer centre. Four patients were lost to follow up while continuing follow up at the cancer centre. Fifteen patients developed recurrent or metastatic disease and were repatriated back to the cancer centre.

Conclusion: A well follow up program for select colorectal cancer patients conducted by primary care providers is feasible and may lead to decreased wait times for new patients. However, a carefully designed quality assurance component of this program is essential. About 32% of discharged patients in this study were not identified in the departmental QA process. An earlier detection of oligo-metastatic disease or a recurrence has a curative potential. To identify the issues related to process, an ongoing feedback from patients, PCP and specialists, as well as a periodic review, is recommended.

Author Disclosure: S. Sigurdson: None. J. Biagi: None. H. Langley: None. A. Mahmud: None.

Samantha Sigurdson, MD

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