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Do nodal counts indicate quality of colon cancer care?

Do nodal counts indicate quality of colon cancer care?

Complete evaluation of the lymph node basin after surgical resection for colon cancer is important for the accurate identification of nodal involvement and for the complete resection of disease.

Recently, the National Quality Forum, in collaboration with ASCO and several other professional groups, endorsed a 12-node minimum as a consensus standard for hospital-based performance. Large private payers have also begun to incorporate this measure into their pay-for-performance program.

But are nodal counts useful indicators of the quality of cancer care? Are patients with fewer than 12 nodes evaluated receiving poor care? Some colorectal surgeons think the answer to these questions is "no" and argue that effort is being misspent to enforce a concept that remains unproven.

More is better

"There is ample evidence that more is better, but based on the strength of the evidence, it may be premature to say that if a surgeon or pathologist cannot achieve more, he or she should not be reimbursed," commented George Chang, MD, assistant professor of surgery, The University of Texas M.D. Anderson Cancer Center.

A number of observational studies have indeed found that the evaluation of an "adequate" number of lymph nodes is associated with increased survival. "There is debate . . . although not as much as it might appear, at least in this regard," he added.

Dr. Chang is principal author of a recent review of 17 studies that validated the findings linking number of evaluated nodes with survival (Chang GJ et al: J Natl Cancer Inst 99:433-441, 2007).

"We have seen that as the number of nodes recovered and dissected by the pathologist increases, survival is improved. There is very little debate about this on the individual patient level," he said.

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