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Most Hospitals Fail Required Colon Cancer Quality Checks

Sep 11, 2008 | Parker Waichman LLP Researchers are reporting this week that most United States hospitals are guilty of medical negligence because they do not meet a key quality standard in the care and treatment of colon cancer patients.  That standard involves checking sufficient lymph nodes following surgery to  see  if the cancer has spread to other areas of the patient’s body.  Leading medical organizations report that doctors should examine no less than 12 lymph nodes to determine if the colon cancer has metastasized and to accurately diagnose the cancer stage, a key indicator of the cancer’s severity.  When a cancer metastasizes, it has moved to other areas in the body.

Colon cancer treatment involves surgery to remove that part of the colon that contains the cancer as well as some healthy tissue on either side of the cancer to help ensure no cancer remains in the organ.  Then, nearby lymph nodes are removed and tested for the presence of cancer.  Checking too few lymph nodes may offer the false impression that the cancer has not spread.

Information from the lymph node checks helps to guide and determine future cancer treatment, including whether or not a patient with metastatic cancer receives the appropriate chemotherapy that can help to improve patient survival.  A review of data from 1,296 U.S. hospitals indicated that only 38 percent of those hospitals checked at least 12 lymph nodes in at least three quarters of those patients who underwent surgery to remove colon cancer in 2004 and 2005.  This means that in the vast majority of cases, a complete check was not undertaken.

This data does indicate an increase over the 15 percent of hospitals that met this standard in 1996 and 1997.  Despite that there has been an increase, the figures are still far below what is recommended, according to the Journal of the National Cancer Institute.  "We were disappointed at how low the compliance rate is still," said Dr. Karl Bilimoria of Northwestern University's Feinberg School of Medicine in Chicago.  Bilimoria led the study.  It is not uncommon to fail to find cancer if only, say, six lymph nodes are checked and to only detect the cancer when more lymph nodes are examined, Bilimoria added.

The researchers continue to try to determine why so few hospitals are meeting the standard.  "Maybe some people don't know that they should be reaching a certain number.  And certainly there may be some people who don't believe that it's important," Bilimoria said.

Information on 82,120 patients treated in 2004 and 2005 was included in the study.  The hospitals that did not meet the standard are treating about two thirds of colon cancer U.S. patients.  The study was released one day following other research, which also raised questions about the quality of U.S. colon cancer care.

Meanwhile, a team led by Dr. Gregory Cooper of University Hospitals Case Medical Center in Cleveland also found that 60 percent of older patients successfully treated for colon cancer did not receive the standard and recommended screening to detect cancer recurrence.

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