TY - JOUR
T1 - Adherence to quality measures improves survival in esophageal cancer in a retrospective cohort study of the national cancer database from 2004 to 2016
AU - Adhia, Akash
AU - Feinglass, Joseph
AU - Schlick, Cary Jo
AU - Odell, David
N1 - Funding Information:
Kathryn Engelhardt, MD assisted in data analysis. Funding: D Odell reports grants from American Cancer Society Grant (K07 CA216330) during the conduct of the study.
Funding Information:
Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at http://dx.doi. org/10.21037/jtd-20-1347 Conflicts of Interest: All authors have completed the IC-MJE uniform disclosure form (available at http://dx.doi. org/10.21037/jtd-20-1347). DO reports grants from American Cancer Society Grant (K07 CA216330) during the conduct of the study. The authors have no other conflicts of interest to declare.
PY - 2020/10
Y1 - 2020/10
N2 - Background: We assessed adherence to four novel quality measures in patients with stage III esophageal cancer, a leading cause of death among GI malignancies. Methods: We performed a retrospective cohort study of 22,871 stage III esophageal cancer patients identified from the National Cancer Database (NCDB) between 2004 and 2016. Four quality measures were defined from published guidelines: administration of induction therapy, >15 lymph nodes sampled, surgery within 60 days of neoadjuvant treatment, and R0 resection. The association of patient demographic and treatment variables with measure adherence was assessed using multiple logistic regression. Risk of all-cause mortality was assessed comparing adherent and non-adherent cases using Cox modeling. Kaplan-Meier survival estimates of groups that adhered to zero to four out of four quality measures were performed. Results: Adherence was high for neoadjuvant treatment (93.7%), timing of surgery (85.7%) and completeness of resection (92.0%), but low for nodal evaluation (45.9%). Medicaid insurance status was associated with decreased odds of adherence for neoadjuvant treatment [odds ratio (OR) 0.73, 95% confidence interval (CI): 0.54-0.99], nodal evaluation (OR 0.81, 95% CI: 0.68-0.96), and completeness of resection (OR 0.71, 95% CI: 0.54-0.92). From 2010 to 2016, when compared to cases from 2004 to 2005, there was a progressive increase in the odds of adequate induction therapy, nodal staging, and completeness of resection, but a progressive decrease in odds of well-timed surgery. Adherence was associated with decreased all-cause mortality for induction therapy, nodal staging, and R0 resection, but not for timing of surgery. Survival improved as the number of quality measures an individual patient adhered to increased. Conclusions: Adherence to quality measures is associated with improved survival in patients with stage III esophageal cancer. Understanding variability in measure adherence may identify targets for quality improvement initiatives.
AB - Background: We assessed adherence to four novel quality measures in patients with stage III esophageal cancer, a leading cause of death among GI malignancies. Methods: We performed a retrospective cohort study of 22,871 stage III esophageal cancer patients identified from the National Cancer Database (NCDB) between 2004 and 2016. Four quality measures were defined from published guidelines: administration of induction therapy, >15 lymph nodes sampled, surgery within 60 days of neoadjuvant treatment, and R0 resection. The association of patient demographic and treatment variables with measure adherence was assessed using multiple logistic regression. Risk of all-cause mortality was assessed comparing adherent and non-adherent cases using Cox modeling. Kaplan-Meier survival estimates of groups that adhered to zero to four out of four quality measures were performed. Results: Adherence was high for neoadjuvant treatment (93.7%), timing of surgery (85.7%) and completeness of resection (92.0%), but low for nodal evaluation (45.9%). Medicaid insurance status was associated with decreased odds of adherence for neoadjuvant treatment [odds ratio (OR) 0.73, 95% confidence interval (CI): 0.54-0.99], nodal evaluation (OR 0.81, 95% CI: 0.68-0.96), and completeness of resection (OR 0.71, 95% CI: 0.54-0.92). From 2010 to 2016, when compared to cases from 2004 to 2005, there was a progressive increase in the odds of adequate induction therapy, nodal staging, and completeness of resection, but a progressive decrease in odds of well-timed surgery. Adherence was associated with decreased all-cause mortality for induction therapy, nodal staging, and R0 resection, but not for timing of surgery. Survival improved as the number of quality measures an individual patient adhered to increased. Conclusions: Adherence to quality measures is associated with improved survival in patients with stage III esophageal cancer. Understanding variability in measure adherence may identify targets for quality improvement initiatives.
KW - Database
KW - Esophageal neoplasms
KW - Esophagectomy
KW - Survival
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U2 - 10.21037/jtd-20-1347
DO - 10.21037/jtd-20-1347
M3 - Article
C2 - 33209378
AN - SCOPUS:85096061720
VL - 12
SP - 5441
EP - 5459
JO - Journal of Thoracic Disease
JF - Journal of Thoracic Disease
SN - 2072-1439
IS - 10
ER -