Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2021

Variability across Victorian hospitals in the care of patients with metastatic colorectal cancer: using comprehensive registry data to explore potential quality indicators. (#153)

Catherine Dunn 1 , Lucy Gately 1 , Jeannie Tie 1 2 3 , Louise Nott 4 , Belinda Lee 1 2 5 , Shehara Mendis 1 3 , Jeremy Shapiro 6 , Vanessa Wong 1 , Matthew Burge 7 , Rachel Wong 1 8 9 10 , Suzanne Kosmider 3 , Margaret Lee 1 3 8 9 , Ross Jennens 2 10 , Peter Gibbs 1 3
  1. Walter and Eliza Hall Research Institute, Melbourne, VIC, Australia
  2. Peter MacCallum Cancer Centre, Melbourne
  3. Western Health, Melbourne
  4. Royal Hobart Hospital, Hobart
  5. Northern Health, Melbourne
  6. Cabrini Health, Melbourne
  7. Royal Brisbane Hospital, Brisbane
  8. Monash University, Melbourne
  9. Eastern Health, Melbourne
  10. Epworth Healthcare, Melbourne

Background
Quality indicators (QI) are essential to monitor the efficacy of cancer care and to guide quality improvement. The majority of oncological QI are derived from ‘expert consensus’ and are not validated against outcomes, and there are a paucity of QI developed for metastatic disease. We aimed to use comprehensive prospective registry data to define and validate novel QI for mCRC.

Methods
Data was analysed from TRACC, a multisite Australian mCRC registry collecting prospective demographic, tumour, treatment and outcome data. We identified patients diagnosed across 11 hospitals and explored variation by site with regards to patient and tumour characteristics, different chemotherapeutic approaches and rates of resection of oligometastatic disease. Kaplan-Meier curves compare overall survival (OS) between sites, and Pearson correlation was used to assess associations.

Results
There were 3132 patients diagnosed with mCRC between July 2009– April 2021. Median age was 66 years (range 62–71 years by site), ECOG 0-1 81% (range 69–96% by site), and Charlson Comorbidity Index ≤2 43% (33–59% by site). Median OS for cohort was 26.2 months (95%CI 24.9–27.3 months), and varied by site from 20.1 – 36.1 months (p=0.001). Rate of triplet chemotherapy (FOLFOXIRI) administration (2.8–13.2% by site) was strongly correlated with OS (R2 =0.851), rate of liver resection (9.8–23.2% by site) was moderately correlated (R2=0.523), and rates of active treatment with first-line chemotherapy (63-90% by site) were weakly correlated (R2 =0.209). Other proposed QI such as rates of lung metastasis resection or chemotherapy administration in the elderly showed significant variation by site, but did not correlate with mOS.

Conclusion
There is significant variation in OS for patients with mCRC in these Australian hospitals, with major differences in treatment approaches. Rates of interventions known to improve survival outcomes, such as triplet chemotherapy and resection of oligometastatic disease, may be potential QI to benchmark and track quality improvement.