Quality of colorectal and anal cancer care delivered during the COVID pandemic.

Authors

null

Melanie Lynn Powis

Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre, Toronto, ON, Canada

Melanie Lynn Powis, Rinku Sutradhar, Saidah Hack, Shabbir M.H. Alibhai, Simron Singh, Abed Baiad, Huaqi Li, Zuhal Mohmand, Monika K. Krzyzanowska

Organizations

Cancer Quality Lab (CQuaL), Princess Margaret Cancer Centre, Toronto, ON, Canada, Institute for Clinical Evaluative Science, Toronto, ON, Canada, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, Sunnybrook Health Sciencies, Toronto, ON, Canada, McGill University, Montreal, QC, Canada, University of Toronto Faculty of Medicine, Toronto, ON, Canada, University of Toronto, Toronto, ON, Canada, Division of Medical Oncology & Haematology, Princess Margaret Cancer Centre, UHN, Toronto, ON, Canada

Research Funding

Other Foundation
Princess Margaret Cancer Foundation, Canadian Institute for Health Research

Background: Reports suggest that there have been significant impacts to the provision of cancer care with delays, interruptions and cancellations across all treatment modalities as a result of the COVID pandemic which have implications for the quality of care. We evaluated the impact of the early phase of the pandemic relative to the same period in the year prior using a panel of measures spanning the six domains of quality; 8 measures focused on pandemic-specific care modifications, and 16 established measures. Methods: The cohort consisted of all new patient consultations between 02/19 to 12/19 (comparator) or 02/20 to 12/20 (COVID) at Princess Margaret Cancer Centre (PM) in Toronto, Canada, who were >18 years of age and newly diagnosed with colon, rectal or anal cancer. Chart abstraction data was linked to Census and the Ontario Marginalization Index datasets to derive additional population-weighted sociodemographic variables. A summary quality score across established measures was computed and a benchmark was set using the pared mean approach representing the top 10% of performers. Associations between achieving the quality benchmark and patient characteristics were evaluated using a multivariable logistic regression model. Results: Relative to the year prior, there was a 12.2% reduction new patient consultations (294 vs 335). Significant findings for individual indicators are summarized below. Relative to English-first language patients, those whose first language was not English were 7.4 times less likely to achieve the benchmark (OR 0.13; 95% CI 0.01-0.61). Compared to those with stage I disease, patients with stage IV disease at diagnosis were 6.5 times less likely to achieve the benchmark (OR: 0.15; 95% CI 0.02-0.78). Conclusions: While overall quality of care was poorer during the early phase of the pandemic, there was a reduction in the proportion of patients treated with systemic therapy within 30 days of death. This likely reflects efforts to prioritize fitter patients with curative disease for treatment and reduce avoidable healthcare utilization. Future work should focus on understanding the downstream impacts of these differences in care quality on clinical outcomes and optimizing preparedness for future disasters.

Quality MeasureCOVID (%)Comparator (%)p-value
Short-course radiotherapy (25Gy, 5 fractions) for rectal cancer32.613.80.03
Premature discontinuation of radiotherapy9.41.10.02
Treatment interruption32.422.30.05
Receipt of appropriate oncologist consultation for colon: consultation with surgical oncologist +/-consultation with a medical oncologist82.490.90.02
30 day post-surgical readmission9.43.60.04
Death within 30 days of systemic therapy1.013.8<0.01

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Abstract Details

Meeting

2023 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session A

Track

Quality, Safety, and Implementation Science,Cost, Value, and Policy,Patient Experience,Survivorship

Sub Track

Quality Improvement Research and Implementation Science

Citation

JCO Oncol Pract 19, 2023 (suppl 11; abstr 432)

DOI

10.1200/OP.2023.19.11_suppl.432

Abstract #

432

Poster Bd #

J14

Abstract Disclosures

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