Mixed adherence to clinical practice guidelines for colorectal cancer in the Southern Netherlands in 2002

Aims: Population-based cancer registries can provide excellent data for insight in disease management practice. This study examines the extent to which the consensus-based national clinical guidelines (version 2000-2001) for colorectal cancer (CRC) had been implemented in the diagnostic and treatment approach in the Southern Netherlands in 2002. Methods: Data were gathered from the medical records for a random sample from the Eindhoven Cancer Registry of 308 patients with colorectal cancer. Adherence to clinical guidelines was determined for diagnostic assessment, pathology, and treatment during the first year after diagnosis. Results: Surgical procedures and referral for pre-operative radiotherapy were carried out largely conform the recommendations. The number of performed colonoscopies among colon cancer patients amounted to 60%; contrast enemas after incomplete colonoscopy were performed in only 27% of patients. The median number of examined lymph nodes was only six for patients with colon and five for patients with rectal cancer; the administration of adjuvant chemotherapy for patients with stage III colon cancer decreased from 95% of patients younger than 70 years to 48% of patients over 70. Conclusions: Adherence to clinical guidelines was not optimal. Feedback to surgeons and pathologists should improve adherence, especially with respect to nodal retrieval and assessment.

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