Quality measures for the use of adjuvant chemotherapy and radiation therapy in patients with colorectal cancer§

A systematic review


  • Presented at the Annual Meeting of the American Radium Society, Maui, Hawaii, May 6–10, 2006.

  • This article was based on research conducted by the Duke Evidence-Based Practice Center under contract to the Agency for Health Care Research and Quality (Contract 290-02-0025), Rockville, MD, in collaboration with the National Cancer Institute, the Centers for Disease Control and Prevention, and the Centers for Medicare and Medicaid Services.

  • §

    The authors of this article are responsible for its contents. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality, the National Cancer Institute, the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, or the U.S. Department of Health and Human Services.



Chemotherapy (CT) and radiation therapy (RT) are essential components of adjuvant (preoperative or postoperative) therapy for many patients with colorectal cancer (CRC); however, quality measures (QMs) of these critical aspects of CRC treatment have not been characterized well. Therefore, the authors conducted a systematic review of the literature to determine the available QMs for adjuvant CT and RT in patients with CRC and rated their usefulness for assessing the delivery of quality care.


The MEDLINE and Cochrane data bases were searched for all publications that contained potential/actual QMs pertaining to adjuvant therapy for CRC. Identified QMs were rated by using criteria developed by the National Quality Forum.


Thirty-two articles met the established inclusion/exclusion criteria. Those 32 articles contained 12 potential or actual QMs, 6 of which had major flaws that limited their applicability. The most useful QMs identified were 1) the percentage of patients with AJCC Stage III colon cancer who received postoperative CT and 2) the percentage of patients with Stage II or III rectal cancer who received chemoradiotherapy.


To the authors' knowledge, very few QMs pertaining to adjuvant CT or RT for CRC have been published to date, and only half of those measures were rated as useful, acceptable, and valid in the current literature review. Future research should focus on refining existing QMs and on developing new QMs that target important leverage points with respect to the provision of adjuvant therapy for patients with CRC. Cancer 2006. © 2006 American Cancer Society.