Definition: The percentage of patients diagnosed with stage II or III rectal cancer who received pre-operative radiation therapy
Numerator: Stage II and III rectal cancer cases receiving pre-operative radiation therapy up to 120 days before resection
Denominator: Stage II and III rectal cancer cases who had a rectal resection within one year of diagnosis
Data source: Provincial cancer agencies
Measurement timeframe: 2009, 2010, 2011 and 2012 diagnosis year
Stratification variables: Province, age group, sex
Provinces submitting data: AB, MB, ON, NB, NS, PE, NL
Province specific notes:
- AB: For 2009, resections were not necessarily limited to the specified types (complete rectum). For 2010/2011/2012, treatment information is based on initially planned treatment to primary site (ACR data). The CCI codes are not identified in the ACR, as such all coded surgeries were included for complete rectum resection. If more than one surgical procedure is performed, the ACR codes the most definitive procedures is documented. The definition of definitive is the surgical procedure with the intent to cure. There are some procedures could not identify the margins are negative. For 2011/2012, through quality assurance, there are a number of cases coded as surgery on the ACR had CCI codes or Billing codes other than the ones listed. The majority of these cases appear to be cases in which the DAD had resection of the rectum even though the patient only had C18.7 sigmoid colon. There are also some cases in which the ACR codes surgery for colon but no records were found in the Inpatient database or Billing data. This may be out of province resection. Cases with radiation therapy after surgery were excluded.
- SK: For 2009, the adjuvant treatment and the site radiation therapy was applied to could not be identified. For 2012, data were not limited to complete resections where margins are negative.
- MB: For 2009, radiation therapy was not limited to primary tumor site. For 2010/2011/2012, data were not limited to complete resections where margins are negative.
- ON: For 2009, radiation therapy was not limited to primary tumor site.
- NB: For 2010, the surgery information was captured in Cancer Registry instead of Discharge Abstract Database. For 2012, all surgeries were included where margins are positive or negative.
- NS: For 2009, cases from Cumberland Health Authority were included. For 2010, collaborative stage variables were used to identify those having resections. Individual charts were reviewed to obtain resection date. Extension codes were used to identify true resections (i.e. polypectomies were not considered resections). For 2010/2011/2012, data were not limited to complete resections where margin is negative.
- PE: For 2009/2010, treatment intent filter was used to identify neo-adjuvant therapy. For 2010/2011, data were not limited to complete resection where margins are negative.
- NL: For 2009/2010, treatment intent filter was used to identify neo-adjuvant therapy. For 2010, margin status was not recorded. Ineligible surgeries were excluded. For 2011/2012, data were limited to complete resections where margin is negative.
- The benefit of pre-operative radiation therapy for patients with tumours of the recto-sigmoid junction is not clear, therefore, the same analysis was conducted including and excluding tumours of the recto-sigmoid junction.
- Rectal cases defined as ICDO3 codes: C19.9 or C20.9, AJCC group stage at diagnosis = II or III.
- Excluded lymphoma codes M-95 to M-98. For 2010/2011/2012, data also excluded sarcoma codes (see Appendix 1), neuroendocrine carcinoma, squamous cell carcinoma.
- Cases for patients under 18 years of age were excluded.
- Rectal resection identified using CCI codes 1NQ87 or 1NQ89 or see list of descriptors in Appendix 1. For 2009/2010, CCI codes also included INQ59.
- Resected cases included regardless of margin status.
- Included cases where the last resection data (if multiple)-diagnosis date<=365 days for 2009. For year 2010, 2011 and 2012, the inclusion definition has been updated to include 1st resection date (if multiple)-diagnosis date<=365.