Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients (NQF 0385)

eMeasure Name Oncology Colon Cancer: Chemotherapy for Stage III Colon Cancer Patients eMeasure Id BA97BDE5-5347-4083-BED1-81EB156D9B81
Version number 1 eMeasure Set Id D5E14C3C-BED4-4B9F-A8B2-EFF55AA52E39
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward American Medical Association - Physician Consortium for Performance Improvement
Endorsed by National Quality Forum
Description Percentage of patients aged 18 years and older with Stage IIIA through IIIC colon cancer who are referred for adjuvant chemotherapy, prescribed adjuvant chemotherapy, or have previously received adjuvant chemotherapy within the 12-month reporting period
Copyright
© 2010 American Medical Association, American Society of Clinical Oncology, and National Comprehensive Cancer Network. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
Patients with Stage IIIA through Stage IIIC colon cancer do not always receive the recommended treatment of adjuvant chemotherapy. This measure is intended to determine whether and how often chemotherapy is administered. The specific chemotherapy drugs specified in this measure reflect the most current guidelines of the National Comprehensive Cancer Network.
Clinical Recommendation Statement
For stage III patients (T1-4, N1-2, M0), the panel recommends 6 months of adjuvant chemotherapy following primary surgical treatment. The treatment options are: 5-FU/LV/oxaliplatin (mFOLFOX6) as the standard of care (category 1); 5-FU/oxaliplatin (FLOX, category 1); capecitabine/oxaliplatin (CapeOx); or single agent capecitabine or 5-FU/LV in patients felt to be inappropriate for oxaliplatin therapy (NCCN). 
There is currently a shortage of leucovorin in the United States.  There are no specific data to guide management under these circumstances, and all proposed strategies are empiric.  The panel recommends several possible options to help alleviate the problems associated with this shortage.  One is the use of levo-leucovorin, which is commonly used in Europe.  A dose of 200 mg/m2 of levo–leucovorin is equivalent to 400 mg/m2 of standard leucovorin.  Another option is for practices or institutions to use lower doses of leucovorin for all doses in all patients, since the panel feels that lower doses are likely to be as efficacious as higher doses, based on several studies...Finally, if none of the above options are available, treatment without leucovorin would be reasonable (NCCN).
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
National Comprehensive Cancer Network (NCCN).  Clinical Practice Guidelines in Oncology:  Colon Cancer.  Version 3, 2011.  Available at:  http://www.nccn.org/professionals/physician_gls/PDF/colon.pdf.
Definition
Initial Patient Population(s): Patient Age:  Patients aged 18 years and older at the beginning of the measurement period
Diagnosis, Active:  Patient has a documented diagnosis of colon cancer.
Encounter:  At least 2 visits with the physician, physician’s assistant, or nurse practitioner during the measurement period.
Definition
Denominator(s): All patients aged 18 years and older with Stage IIIA through IIIC colon cancer.
Definition
Denominator Exclusion(s): N/A
Definition
Numerator(s): Patients who are referred for adjuvant chemotherapy, prescribed adjuvant chemotherapy, or who have previously received adjuvant chemotherapy within the 12 month reporting period.
Definition
Denominator Exception(s): Documentation of medical reason(s) for not referring for or prescribing adjuvant chemotherapy (eg, medical co-morbidities, diagnosis date more than 5 years prior to the current visit date, patient’s cancer has metastasized, medical contraindication/allergy, poor performance status, patient older than 80 years of age).
Documentation of patient reason(s) for not referring for or prescribing adjuvant chemotherapy (eg, patient refusal).
Documentation of system reason(s) for not referring for or prescribing adjuvant chemotherapy (eg, patient is currently enrolled in a clinical trial that precludes prescription of chemotherapy).
Guidance
The denominator for this measure has been limited to patients with a first recorded colon cancer diagnosis during the 12 month reporting period. The numerator captures patients who are prescribed adjuvant chemotherapy or received adjuvant chemotherapy during the 12 month period. "Referred for Chemotherapy" is not separately specified, as this option can be captured either through the Medication Order: Chemotherapy for Colon Cancer" numerator option or the patient reason exclusion: "Medication, Administered not done: Patient reason" for "Chemotherapy for Colon Cancer RxNorm." Medical reasons for exclusions might include acute renal insufficiency, neutropenia, or leucopenia. Date of diagnosis is defined as the date of pathologic diagnosis.
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012