Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2024

Concordance of colorectal cancer care with Optimal Care Pathway recommendations: a pre-post study (#407)

Rebecca J Bergin 1 2 3 , Dallas English 2 4 , Sabrina Wang 2 4 , Jon D Emery 1 , David Hill 5 6 7 , Kathryn Whitfield 8 , Robert J Thomas 2 9 , Anna Boltong 10 11 , Paul Mitchell 12 , David Roder 13 , Euan Walpole 14 15 , Roger L Milne 2 4 16 , Victoria White 6 17
  1. Department of General Practice and Primary Care, University of Melbourne, Melbourne, Vic, Australia
  2. Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
  3. Centre for Quality and Patient Safety Research, Institute of Health Transformation, Deakin University, Geelong, Vic, Australia
  4. Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
  5. Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia
  6. Behavioural Science Division, Cancer Council Victoria, Melbourne, VIC, Australia
  7. Health Behaviour Research Collaborative, University of Newcastle, Callaghan, NSW, 2308
  8. Victorian Government, Melbourne, Vic, Australia
  9. Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic, Australia
  10. Department of Nutrition, Dietetics and Food, , Monash University, Clayton, Vic, Australia
  11. Kirby Institute, University of New South Wales, Sydney, NSW, Australia
  12. Austin Health, Melbourne, Vic, Australia
  13. Cancer Institute NSW, Sydney, NSW, Australia
  14. Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia
  15. Department of Oncology, Princess Alexandra Hospital, Brisbane, Qld, Australia
  16. Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
  17. School of Psychology, Deakin University, Melbourne, VIC, Australia

Aims: Optimal Care Pathways (OCPs) are standards for cancer care that aim to reduce unwarranted variation and improve patient outcomes. This study compared concordance with colorectal cancer OCP recommendations before and after the introduction of OCPs in Victoria, Australia.

Methods: Cross-sectional surveys were conducted of two groups of patients identified by the Victorian Cancer Registry with a primary colorectal cancer, and their general practitioners (GPs): the first in 2012-2014 (pre-OCP), the second in 2018-2019 (post-OCP). Poisson regression examined the relative difference in the proportion of patients receiving care concordant with OCP recommendations for timeliness of care, diagnostic investigations and treatment, before and after implementation. Exploratory analyses examined disparities in timeliness of care by socio-economic position or remoteness of residence.

Results: The pre-OCP group included 413 patients (43% response) and 275 GPs; the post-OCP group 320 patients (34% response) and 201 GPs. Surveys were completed a median 6-months (pre-OCP) and 7-months (post-OCP) post-diagnosis.

Both groups had similar concordance with recommended timeframes to receive a colonoscopy or surgeon appointment, and to start neoadjuvant treatment or adjuvant chemotherapy. Concordance with recommendations for investigating symptoms was lower in the post-OCP group, especially for physical examination (relative risk [RR]=0.71; 95% confidence interval [CI] 0.57-0.89, p=.003). Rectal cancer patients were more likely to have an MRI post-OCP (RR=1.31; 95%CI 1.03-1.66, p=.027).

Estimates consistently indicated that patients residing in rural or low socio-economic areas were less likely to receive care in accordance with OCP recommended timeframes than their urban, high socio-economic counterparts. Disparities by socio-economic status were consistent pre- and post-OCP, but disparities by remoteness increased.

Conclusions: There were limited changes in delivery of OCP recommended care early after policy introduction. A comprehensive implementation strategy is needed to embed OCPs in practice, with a sustained focus on disparities, given existing and growing inequities for some populations.