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Colon Cancer Care: Not Good Enough

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Proper treatment for colorectal cancer includes excising the tumor, surrounding tissue and nearby lymph nodes, and then checking the nodes for metastatic spread. Oncologists decide whether to give adjuvant therapy based on the lymph node analysis. If the tumor has spread but the lymph node analysis fails to pick this up, then the patient does not receive appropriately aggressive adjuvant therapy.

Twelve years ago, oncologists established a guideline to measure the quality of colorectal cancer care. The guideline calls for pathologists to examine at least 12 lymph nodes for metastatic spread in 75% of all tissue blocks received from presumed colorectal cancer surgeries. Back then, only 15% of hospitals met the guideline.

Now we have new data. The results are better, but far from adequate. Only 38% of hospitals meet the guideline [2], according to data soon to be released in the Journal of the National Cancer Institute. Community hospitals meet the guideline only 34% of the time, whereas comprehensive cancer centers meet it 78% of the time [3].

Why the poor results? Perhaps doctors don’t know they should check so many nodes. Perhaps they don’t understand the importance of lymph node analysis in determining adjuvant therapy. Perhaps surgeons don’t provide enough nodes to the pathologists, or pathologists don’t have time to analyze that many nodes. Maybe tissue preparation and storage techniques are inadequate.

Providers that are serious about improving care will embrace the new findings and start exploring these hypotheses one by one.