Purpose: This study was performed in order to evaluate if patients were offered or received appropriate workup and treatment according to colon cancer stage. Rectal cancer was diagnosed in 3 and colon cancer in 81 patients over 5 years. Patients were diagnosed with stage I in 26 cases (30%), stage II in 21 cases (25%), stage III in 15 cases (17.9 %), stage IV in 21 cases (25%), and 1 patient TIS (0.1%).
Methods: The study was designed as a retrospective single institution (JJP VAMC ) chart review of all patients who were diagnosed with colorectal cancer from 1/1/2008-12/31/2012 which included a total of 86 patients. NCCN guidelines 2014 were used as reference for workup, treatment and surveillance according to TNM classification. Data elements included the following: pre-operative CEA/ CT chest, abdomen, pelvis, colonoscopy; surgical resection and chemotherapy; follow up CEA, CT, colonoscopy. Excluded patients included those who eloped or were permanently lost follow up.
Results: Complete workup was done in 64% cases, incomplete in 36% cases without significant difference from 2008-2012. Incomplete workup defined as: missing CT chest (in 100% of those cases CXR was done and without mass suggestive for metastasis) 11 cases, CEA 3 cases, CT abdomen, pelvis and chest in 1 case, and both CT and CEA in 7 cases. Stage IV colorectal carcinoma patients were tested for KRAS/BRAF in 10 cases (47.6%; 3 KRAS positive, 7 negative) and not tested in 11 cases (52.4%). However, there has been progressive improvement in following guidelines for testing of KRAS from 2008-2012 from 45% (2008), 50% (2009), 75% (2010), 75% (2011) to 100% in 2012.
Treatment was found to have 100% compliance with NCCN guidelines according to TNM classification. Surveillance according to NCCN guidelines was in full compliance in 59 cases (77.7%), incomplete follow up in 17 cases (22.3%) with missing CT chest or CEA, and from which only 1 patient was missing follow up colonoscopy (1.3%).
Conclusions: Complete compliance with 100% appropriate therapy was offered to veterans at one VA according to NCCN guidelines from 2008-2012. Aside from omitting CT chest when replaced by normal CXR, workup was complete in 90% of cases. Improvement in testing for KRAS/BRAF in stage IV colorectal carcinoma was done over the years with achievement of 100% in 2012. Surveillance was satisfactory as incomplete follow up was found in only 20%. Given the future emphasis on cancer survivorship, a focus on adherence to surveillance should be a strong part of the VA’s future goals.
