Pre-Treatment Staging Imaging in Rectal Cancer: Results From the Quality Oncology Practice Initiative

Area of Science:

• Oncology
• Radiology
• Health Services Research

Background:

• National Comprehensive Cancer Network guidelines recommend specific imaging for nonmetastatic rectal cancer staging.
• Accurate staging (T and N) is crucial for determining optimal treatment strategies.
• This study evaluates adherence to these staging guidelines in clinical practice.

Purpose of the Study:

• To assess practice concordance with National Comprehensive Cancer Network guidelines for rectal cancer staging.
• To identify factors contributing to nonconcordance in staging workup.
• To evaluate trends in guideline adherence over time.

Main Methods:

• Utilized data from 103 Quality Oncology Practice Initiative (QOPI)-participating practices from Fall 2016 to Fall 2019.
• Analyzed performance on QOPI measure Colorectal 78 for guideline-concordant imaging.
• Employed logistic regression for trend analysis and surveyed practices on reasons for nonconcordance.

Main Results:

• Guideline-concordant staging increased from 38% in Fall 2016 to 56% in Fall 2019.
• Nonconcordance was primarily due to poor care coordination (57.1%) and lack of awareness of appropriate scans (28.6%).
• Data from 1,158 unique patients across 20-33 practices per time point were analyzed.

Conclusions:

• Despite improvement, a significant proportion of patients still do not receive appropriate staging imaging.
• Quality improvement initiatives focusing on multidisciplinary team coordination are needed.
• Addressing care coordination and provider awareness can improve adherence to rectal cancer staging guidelines.