Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2019

Alignment with indices of a care pathway is associated with improved survival - An observational population-based study in colon cancer patients (#26)

Luc te Marvelde 1 , Peter McNair 2 , Kathryn Whitfield 3 , Philippe Autier 4 , Peter Boyle 4 , Richard Sullivan 5 , Robert JS Thomas 6
  1. CCV / DHHS, Melbourne, VIC, Australia
  2. Victorian Agency for Health Information, Melbourne, Victoria, Australia
  3. Cancer Strategy & Development, Department of Health and Human Services, Melbourne, Victoria, Australia
  4. International Prevention Research Institute (iPRI), Lyon, France
  5. Institute of Cancer Policy, King’s College London, London, UK
  6. University of Melbourne, Melbourne, Victoria, Australia

Introduction Causes of variations in outcomes from cancer care in developed countries are often unclear. Australia has developed health system pathways describing consensus standards of optimal cancer care across the phases of prevention through to follow-up or end-of-life. These Optimal Care Pathways (OCP) were introduced from 2013-14. We investigated whether care consistent with the OCP improved outcomes for colon cancer patients.

Methods Colon patients diagnosed from 2008-2014 were identified from the Australian State of Victoria Cancer Registry (VCR) and cases linked with State and Federal health datasets. Surrogate variables describe OCP alignment in our cohort, across three phases of the pathway; prevention, diagnosis and initial treatment and end-of-life. We assessed the impact of alignment on (1) stage of disease at diagnosis and (2) overall survival.

Results Alignment with the prevention phase of the OCP occurred for 88% of 13,539 individuals and was associated with lower disease stage at diagnosis (OR = 0.33, 95% confidence interval 0.24 to 0.42), improved crude three-year survival (69.2% versus 62.2%; p<0.001) and reduced likelihood of emergency surgery (17.7% versus 25.6%, p<0.001). For patients treated first with surgery (n=10,807), care aligned with the diagnostic and treatment phase indicators (44% of patients) was associated with a survival benefit (risk-adjusted HRnon-aligned vs aligned=1.23, 95% confidence interval 1.13 to 1.35), better perioperative outcomes and higher alignment with follow-up and end-of-life care. The survival benefit persists adjusting for potential confounding factors, including age, sex, disease stage and comorbidity.

Conclusion This population-based study shows that care aligned to a pathway based on best principles of cancer care is associated with improved outcomes for patients with colon cancer.