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.

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The receipt of adjuvant chemotherapy in AJCC Stage III colon cancer patients following primary surgical treatment is associated with a significant survival benefit.

For stage III patients (T1-4, N1-2, M0), the panel recommends 6 months of adjuvant chemotherapy following primary surgical treatment. The treatment options are: 5-FU/LV/oxaliplatin (mFOLFOX6) as the standard of care (category 1); bolus 5-FU/LV/oxaliplatin (FLOX, category 1); capecitabine/oxaliplatin (CapeOx); or single agent capecitabine (category 2A) or 5-FU/LV (category 2A) in patients felt to be inappropriate for oxaliplatin therapy. (NCCN, 2012) 

There is currently a shortage of leucovorin in the United States. There are no specific data 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 levo-leucovorin, which is commonly used in Europe. A dose of 200 mg/m2 of levo–leucovorin is equivalent to 400 mg/m2 of standard leucovorin. Another option is for practices or institutions to use lower doses of leucovorin for all doses in all patients, since 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 are available, treatment without leucovorin would be reasonable. (NCCN)

Higher score indicates better quality

National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Colon Cancer. Version 2, 2012. Available at: http://www.nccn.org.

Adjuvant Chemotherapy – According to current NCCN guidelines, the following therapies are recommended: 5-FU/LV/oxaliplatin (mFOLFOX6) as the standard of care (category 1); bolus 5-FU/LV/oxaliplatin (FLOX, category 1); capecitabine/oxaliplatin (CapeOx, category 1); or single agent capecitabine (category 2A) or 5-FU/LV (category 2A) 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.

The measure logic includes the combination of 5-FU/LV/oxaliplatin which will capture either mFOLFOX6 or FLOX, category 1, as referenced in the definitions section.  
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.

TBD

All patients aged 18 through 80 years with colon cancer

Equals Initial Patient Population with AJCC Stage III colon cancer

None

Patients who are referred for adjuvant chemotherapy, prescribed adjuvant chemotherapy, or who have previously received adjuvant chemotherapy within the 12 month reporting period

Not Applicable

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)

Not Applicable

Not Applicable

For every patient evaluated by this measure also identify payer, race, ethnicity and sex.