Table 2.
Core measure indicators for colorectal cancer
| Indicator | Description | Numerator | Denominator | Evidence level or grade of recommendation | Rationale |
|---|---|---|---|---|---|
| PT1 | Proportion of colorectal patients who have pre-operative chest X-ray and abdominal ultrasound, CT scan or MRI18 | Number of colorectal patients who have pre-operative chest x-ray and abdominal ultrasound, CT scan or MRI (including off-site) | Number of all colorectal patients | Grade C | Comprehensive-ness of pre-operative evaluation |
| T1 | Proportion of colorectal patients who have undergone surgical resection for colon or rectal cancer have documentation that colonoscopy or barium enema with sigmoidoscopy was offered within 6 months before or after surgery19,20 | Number of colorectal patients who have undergone surgical resection for colon or rectal cancer have documentation that colonoscopy or barium enema with sigmoidoscopy (including off-site) was offered within 6 months before or after surgery | Number of colorectal patients who have undergone surgical resection for colon or rectal cancer | Level II-2 | Synchronous colon or rectal cancer |
| T2* | Proportion of colorectal patients who have undergone wide surgical resection for malignant polyp of colon or rectum within 6 weeks of pathological report (polypectomy) revealing incomplete or positive margin or venous or lymphatic invasion or poorly undifferentiated19 | Proportion of colorectal patients who have undergone wide surgical resection for malignant polyp of colon or rectum within 6 weeks of pathological report (polypectomy) revealing incomplete or positive margin or venous or lymphatic invasion or poorly undifferentiated | Number of colorectal patients who pathological report for malignant polyp of colon or rectum revealing incomplete or positive margin or venous or lymphatic invasion or poorly undifferentiated | Level II-2, III | Increase curability |
| T3a | Proportion of patients who are diagnosed with colon cancer and do not have metastatic disease were offered a curative resection within 6 weeks of diagnosis. (For patient with diagnosis and treatment of care in the same hospital)19,23 | Number of patients who are diagnosed with colon cancer and do not have metastatic disease were offered a curative resection within 6 weeks of diagnosis. (For patient with diagnosis and treatment of care in the same hospital) | Number of patients who are diagnosed with colon cancer and do not have metastatic disease. (For patient with diagnosis and treatment of care in the same hospital) | Level II-2, III | Improve survival |
| T3b | Proportion of patients who are diagnosed with colon cancer and do not have metastatic disease were offered a curative resection within 6 weeks of diagnosis19,23 | Number of patients who are diagnosed with colon cancer and do not have metastatic disease were offered a curative resection within 6 weeks of diagnosis | Number of patients who are diagnosed with colon cancer and do not have metastatic disease | Level II-2, III | Improve Survival |
| T4 | Proportion of stage I to III colorectal patients who have histopathology reports which give the degree of involvement of surgical margins, including circumferential margins, the number of lymph nodes examined and the number involved21, 22 | Number of stage I to III colorectal patients who have histopathology reports which give the degree of involvement of surgical margins, including circumferential margins, the number of lymph nodes examined and the number involved | Number of stage I to III colorectal patients excluding patients undergo polypectomy | Grade B | Provide information for subsequent intervention, which related to tumor recurrence |
| T5 | Proportion of stage I to III colorectal patients who undergo a wide surgical resection that have documented to be "negative margins"19,23 | Number of stage I to III colorectal patients who undergo a wide surgical resection that have documented to be "negative margins" | Number of stage I to III colorectal patients excluding no pathological report regarding status of margin | Level II-2, III | Radical excision |
| T6 | Proportion of colorectal patients who undergo a surgery that have a pathology report with the information on tumor size and node differentiation22,24 | Number of colorectal patients who undergo a surgery that have a pathology report with the information on tumor size and node differentiation | Number of colorectal patients who undergo a surgery | Class B | Provide information for subsequent intervention and follow-up |
| T7 | Proportion of I to III stage colorectal cancer patients with twelve or more lymph nodes on pathology report25 | Number of I to III stage colorectal cancer patients with twelve or more lymph nodes on pathology report | Number of I to III stage colorectal cancer patients excluding polypectomy, or neo-radiotherapy | Level III or IV | Radical excision and pathological accountability |
| T8* | Proportion of pathological report according to CAP checklist or similar one21,26 | Number of pathological report according to CAP checklist or similar one | Number of colorectal patients | Pathological report comprehensiveness | |
| T9 | Proportion of stage III colon cancer patients who was offered chemotherapy within 6 weeks after surgery19,27,28 | Number of stage III colon cancer patients who was offered chemotherapy within 6 weeks after surgery | Number of stage III colon cancer patients who was offered chemotherapy after surgery (in the same hospital) | Level I, II-2, III | Increase Survival |
| T10 | Proportion of patients who are diagnosed with Stage II or III rectal cancer, was offered treatment including surgery, radiotherapy, or CCRT treatment within 6 weeks of diagnosis19,24 | Number of patients who are diagnosed with Stage II or III rectal cancer, was offered treatment including surgery, radiotherapy, or CCRT treatment within 6 weeks of diagnosis | Number of patients who are diagnosed with Stage II or III rectal cancer, was offered treatment in the same hospital | Level II-2, III | Avoid treatment delay |
| T11 | Proportion of patients who are diagnosed with rectal cancer that appears clinically to be Stage II or III, and was offered surgical resections within 16 weeks after beginning of CCRT19,23 | Number of patients who are diagnosed with rectal cancer that appears clinically to be Stage II or III, and was offered surgical resections within 16 weeks after beginning of CCRT | Number of patients who are diagnosed with rectal cancer that appears clinically to be Stage II or III, and was offered CCRT before surgery | Level II-2, III | Provide treatment for cure intent |
| F1* | Proportion of patients who had completed all courses of therapy for Stage I to III lesions had medical check-up again within 6 months of completion19,29 | Number of patients who had completed all courses of therapy for Stage I to III lesions had medical check-up again within 6 months of completion | Number of patients who had completed all courses of therapy for Stage I to III lesions | Level II-2, III | Decrease mortality |
| F2* | Proportion of patients who had completed surgery for Stage I to III lesions had medical check-up again including colonoscopy or LGI series within 2 years period and subsequent 3 years interval19 | Number of patients who had completed surgery for Stage I to III lesions had medical check-up again including colonoscopy or LGI series within 2 years period and subsequent 3 years interval | Number of patients who had Stage I to III lesions | Level II-2, III | Decrease recurrence |
| F3* | Proportion of patients who are treated by polypectomy procedure for malignant polyp was offered colonoscopy within 12 months of procedure19,30 | Number of patients who are treated by polypectomy procedure for malignant polyp was offered colonoscopy within 12 months of procedure | Number of patients who are treated by polypectomy procedure for malignant polyp | Level III | Decrease recurrence |
| F4* | Five-year over-all survival rate, stage specific (Stage I to IV)28 | Number of patients who survive at five-year period, stage specific (Stage I to IV) | Number of patients, stage specific (Stage I to IV) | Class C | Assess survival |
| F5* | Five-year local recurrence rate, stage specific (Stage I to III)18 | Number of patients who had recurrence at five-year period, stage specific (Stage I to III) | Number of patients, stage specific (Stage I to III) | Grade B | Assess recurrence |
*: indicators excluded in the results due to data un-available.
1. Stage I to IV are based on classification of TNM system, AJCC (the American Joint Committee on Cancer);
2. Level I, Level II-2, Level III and Level IV: adopted from RAND19, Desch29; Class B: adopted from SIGN 200322; Class C: adopted from Guideline 200128; Grade B and Grade C: adopted from RCSI 200218; see Additional file 1 for definition.
3. PT: pre-treatment; T: treatment; F: follow-up; CT: computed tomography; MRI: magnetic resonance imaging; CAP: College of American pathology; CCRT: concurrent chemo-irradiation; LGI series: Lower gastrointestinal series.