Thursday, September 11, 2008
The Washington Post reports that according to a study advising patients to ask about quality of care before surgery, nearly two-thirds of hospitals fail to check colon cancer patients well enough for signs that their tumor is spreading. Lauren Neergaard writes,
National guidelines say when colon cancer is removed, doctors should check at least 12 lymph nodes for signs of spread. Checking fewer than 12 isn't considered enough to be sure the cancer is contained.
But a study of nearly 1,300 hospitals found that overall, just 38 percent fully comply with the guideline, Northwestern University researchers report Tuesday in the Journal of the National Cancer Institute.
"It's a fairly simple thing we can do to try to improve care for our patients," said lead author Dr. Kyle Bilimoria, of Northwestern and the American College of Surgeons.
Colorectal cancer is the nation's second leading cancer killer, set to claim almost 50,000 lives this year.
Some 148,000 Americans are diagnosed annually. For many, the node check can be crucial. Whether cancer has entered these doorways to the rest of the body is an important factor in long-term survival _ and thus helps doctors decide who gets chemotherapy after surgery and who can skip it.
"Patients who could benefit from additional chemotherapy may not be getting complete treatment and have a higher chance of relapse," said Dr. Durado Brooks of the American Cancer Society, who wasn't involved with the study. "It is something that consumers need to begin asking. ... Frankly, that is most likely to change medical practice."
To check enough nodes, surgeons must remove enough of the fat tissue by the colon where they hide, and pathologists must painstakingly dissect that tissue to find the tiny nodes.
Surgeons frequently tell of getting a pathology report of four clean nodes and asking the pathologist to find more, "and lo and behold, one of those additional nodes turns out to be positive," Bilimoria said.
Previous studies have estimated that up to half of colon cancer patients have at least 12 nodes checked. Bilimoria's study is the first look at which hospitals are most likely to follow the guideline _ and will report the rates directly to each institution. His team examined a national cancer database for records showing which hospitals checked 12 or more lymph nodes in at least 75 percent of eligible patients in 2004 and 2005, the latest data available.
National Cancer Institute-designated "Comprehensive Cancer Centers" did the best job, with 78 percent complying. Just under 34 percent of community hospitals, which are far more common and care for many more patients, complied. Just over half of other academic medical centers and Veterans Administration hospitals met the standard.
Improvement takes work from both surgeons and pathologists, Bilimoria said, noting that Northwestern went from about 50 percent compliance a decade ago to full compliance today.
But he expects more 12-node checks soon, saying the National Quality Forum recently listed the standard as a sign of quality care and that at least one insurance giant has begun requiring proof of 12-node checks before listing surgeons as preferred providers.
Meanwhile, he advises patients to ask about the 12-node check in choosing a surgeon and to check their pathology report to be sure it was done.