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The article presents a literary review of available evidence for quality indicators (QI) that can be used to assess the screening and treatment of colorectal cancer in vulnerable elders (VE). The review included 138 articles about colorectal cancer. A description of the 21 QI which were judged by an expert panel as valid is presented, including comorbidity, pretreatment computed tomography and surgical outcome discussion. The supporting evidences for each QI are also explained.

Most literature available on rare colorectal cancer (CRC) is from case series reports. This population-based evaluation is the first comprehensive look at four rare histologic types of CRC, allowing comparisons with the more common adenocarcinoma for clinical and pathological features and survival rates. All patients diagnosed with carcinoid ( n=2,565), malignant lymphoma ( n=955), non-carcinoid neuroendocrine ( n=455), squamous cell ( n=437), and adenocarcinoma ( n=164,638) in SEER cancer database (1991–2000) were analyzed. Evaluation of age-adjusted incidence rate, stage at presentation, and 5-year relative survival were determined for each histologic subtype. All rare histologic subtypes had younger mean age than adenocarcinomas (70 years; p<0.05). Lymphoma was more common in males (65.1%; P<0.01). Incidence rates in 2000 per million were: carcinoid 10.6, lymphoma 3.5, neuroendocrine 2.0, squamous 1.9, and adenocarcinoma 496.3. The annual percent change in incidence for each rare tumor increased significantly during the 10 years (range: 3.1–9.4%, p<0.05), except squamous cell carcinoma (5.9%, p>0.05). Squamous (93.4%) and carcinoid (73.7%) tumors occurred more often in the rectum; lymphoma (79.0%), neuroendocrine (70.8%), and adenocarcinoma (70.1%) occurred more often in the colon ( P<0.01). Carcinoids presented at earlier stage (localized/regional, 90.5%) more often than adenocarcinoma (80.6%; p<0.01), but squamous cell (82.1%; p=0.50), lymphoma(70.6%; p<0.01), and neuroendocrine (37.8%; p<0.01) presented at earlier stage similarly or less often than adenocarcinoma. Relative 5-year survival rate was highest for carcinoid (91.3%), and lowest for neuroendocrine tumors (21.4%). This study provides the first population-based analysis of the epidemiology, tumor characteristics, and survival rates for rare CRC. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer is the second most common cancer type among new cancer diagnoses in the United States. Attention to the quality of surgical care for colorectal cancer is of particular importance given the increasing numbers of colorectal cancer resections performed in the aging population. A National Cancer Institute-sponsored consensus panel produced guidelines for colorectal cancer surgery in 2000. We have updated and extended that work by using a formal process to identify and rate quality indicators as valid for care during the preoperative, intra- operative, and postoperative periods. Methods: Using a modification of the RAND/UCLA Appropriateness Methodology, we carried out structured interviews with leaders in the field of colorectal cancer surgery and systematic reviews of the literature to identify candidate quality indicators addressing perioperative care for patients undergoing surgery for colorectal cancer. A panel of 14 colorectal surgeons, general surgeons, and surgical oncologists then evaluated and formally rated the indicators using the modified Delphi method to identify valid indicators. Results: A total of 142 candidate indicators were identified in six broad domains: privileging (which addresses surgical credentials), preoperative evaluation, patient-provider discussions, medication use, intraoperative care, and postoperative management. The expert panel rated 92 indicators as valid. These indicators address all domains of perioperative care for patients undergoing surgery for colorectal cancer. Conclusions: The RAND/UCLA Appropriateness Methodology can be used to identify and rate indicators of high-quality perioperative care for patients undergoing surgery for colorectal cancer. The indicators can be used as quality performance measures and for quality-improvement programs. [ABSTRACT FROM AUTHOR]

The article provides a comprehensive analysis on the underuse of appropriate adjuvant therapy in colorectal cancer. Colorectal cancer patients who were diagnosed from the period 1994 to 2001 were studied by the authors. Their characteristics, including ethnicity and race, were used in five different multivariate regression analysis to predict receipt of chemotherapy for stage 3 colon cancer and receipt of chemotherapy and radiation therapy for stages 2 and 3 rectal cancer.