eMeasure Title

Colon Cancer: Chemotherapy for AJCC Stage III Colon Cancer Patients

eMeasure Identifier (Measure Authoring Tool) 141 eMeasure Version number 5.0.000
NQF Number 0385 GUID 8479f6d6-4200-4fd0-9438-30048ebe3e29
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)
Measure Developer American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)
Endorsed By National Quality Forum
Description
Percentage of patients aged 18 through 80 years with AJCC Stage III colon cancer who are referred for adjuvant chemotherapy, prescribed adjuvant chemotherapy, or have previously received adjuvant chemotherapy within the 12-month reporting period.
Copyright
Copyright 2014 American Society of Clinical Oncology, National Comprehensive Cancer Network Association and American Medical Association. All Rights Reserved.
Disclaimer
Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]), American Society of Clinical Oncology, and National Comprehensive Cancer Network. These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI). Neither the AMA, PCPI nor its members shall be responsible for any use of the Measures. 

THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. 

Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, American Society of Clinical Oncology, National Comprehensive Cancer Network, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT(R)) or other coding contained in the specifications. 

CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.

Due to technical limitations, registered trademarks are indicated by (R) or [R].
Measure Scoring Proportion
Measure Type Process
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
The receipt of adjuvant chemotherapy in AJCC Stage III colon cancer patients following primary surgical treatment is associated with a significant survival benefit.
Clinical Recommendation Statement
For patients with stage III disease, the panel recommends 6 months of adjuvant chemotherapy after primary surgical treatment. The treatment options are: FOLFOX or CapeOx (both category 1 and preferred); FLOX (category 1); or single-agent capecitabine or 5-FU/LV in patients for whom oxaliplatin therapy is believed to be inappropriate. (NCCN, 2015) 

A shortage of LV recently existed in the United States. No specific data are available 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 levoleucovorin, which is commonly used in Europe. A dose of 200 mg/m2 of leucovorin is equivalent to 400 mg/m2 of standard LV. Another option is for practices or institutions to use lower doses of LV for all doses in all patients, because 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 is available, treatment without LV would be reasonable. For patients who tolerate this without grade II or higher toxicity, a modest increase in 5-FU dose (in the range of 10%) may be considered. (NCCN, 2015)
Improvement Notation
Higher score indicates better quality
Reference
National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Colon Cancer. Version 2.2015. Available at: http://www.nccn.org.
Definition
Adjuvant Chemotherapy - According to current NCCN guidelines, the following therapies are recommended: 5-FU/LV/oxaliplatin (FOLFOX) or capecitabine/oxaliplatin (CapeOx) (both category 1 and preferred); bolus 5-FU/LV/oxaliplatin (FLOX) (category 1); or single-agent capecitabine or 5-FU/LV in patients felt to be inappropriate for oxaliplatin therapy (NCCN). See clinical recommendation statement for cases where leucovorin is not available.       

Prescribed - May include prescription ordered for the patient for adjuvant chemotherapy at one or more visits in the 12-month period OR patient already receiving adjuvant chemotherapy as documented in the current medication list.
Guidance
The measure logic option that includes the combination of 5-FU/LV/oxaliplatin will capture either FOLFOX or FLOX.  

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 exception: "Medication, Administered not done: Patient reason" for "Chemotherapy for Colon Cancer". Additional valid medical reason exceptions might include acute renal insufficiency, neutropenia, or leukopenia. Date of diagnosis is defined as the date of pathologic diagnosis. 

The requirement of "Count >=2 of Encounter, Performed" is to establish that the eligible professional has an existing relationship with the patient.
Transmission Format
TBD
Initial Population
All patients aged 18 through 80 years with colon cancer
Denominator
Equals Initial Population with AJCC Stage III colon cancer
Denominator Exclusions
None
Numerator
Patients who are referred for adjuvant chemotherapy, prescribed adjuvant chemotherapy, or who have previously received adjuvant chemotherapy within the 12 month reporting period
Numerator Exclusions
Not Applicable
Denominator Exceptions
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 diagnosis date is within 120 days of the end of the 12 month reporting period, patient's cancer has metastasized, medical contraindication/allergy, poor performance status, other medical reasons)
Documentation of patient reason(s) for not referring for or prescribing adjuvant chemotherapy (eg, patient refusal, other patient reasons)
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, other system reasons)
Measure Population
Not Applicable
Measure Population Exclusions
Not Applicable
Measure Observations
Not Applicable
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Table of Contents


Population Criteria

Data Criteria (QDM Variables)

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables


Measure Set
None