Assessment of Breast and Colorectal Cancer Surgery in Manitoba Iresha Ratnayake, MSc NAACCR/IACR 2019

Project Team Charlene Muzyka, MSc Natalie Biswanger, BSc Pamela Hebbard, MD Jason Park, MD Kathleen Decker, PhD Donna Turner, PhD Helmut Unruh, MD

Disclaimer The results and conclusions are those of the authors and no official endorsement by Manitoba Health, or other data providers is intended or should be inferred.

Background Surgery is the primary treatment modality for patients with breast and colorectal cancer. Measuring treatment patterns and quality of surgery are essential to evaluating health system performance. This evaluation has not previously been done in Manitoba.

Purpose To develop and measure comprehensive, integrated, and evidence-based indicators regarding surgical quality and clinical outcomes. Provide province-wide leadership in cancer surgery. Identify opportunities to improve cancer surgery quality, inform service planning, and support policy development.

Objective The objective of this study was to measure surgical treatment patterns, assess quality of care, and evaluate post-operative outcomes for individuals diagnosed with breast and colorectal cancers.

Methods Study Population: Individuals aged 20+ diagnosed with breast, colon, or rectal cancers between 2010-2014 Data Sources: Manitoba Cancer Registry, Discharge Abstracts Database, Medical Claims Descriptive statistics

Descriptive Indicators Incidence Stage distribution Description of surgical practices – E.g., Number of surgeries, types of procedures, surgical approach etc.

Quality Indicators Breast Time between surgical consult and surgery Re-excision among women who underwent breast conserving surgery Negative axillary clearance among women with no nodal metastasis Colorectal Time between colonoscopy and surgery ≥12 lymph node removal and examination Rectal cases with a positive circumferential resection margin

Post-Operative Outcomes Post-operative complications Length of hospital stay Hospital re-admissions

Results Percentage of women diagnosed with invasive breast cancer that had their first surgery in the same RHA in which they lived at diagnosis, 2010-2014

Goal: Increase rates of immediate reconstruction by 10% by March 2020 Results Percentage of breast cancer surgeries, by procedure type, by regional health authority, 2010-2014 Goal: Increase rates of immediate reconstruction by 10% by March 2020

Results Percentage of women with breast cancer and no positive nodes, who received axillary clearance, by region, 2010-2014 Goal: Decrease rates of axillary clearance among women with no nodal metastasis by 10% by March 2020

Results Percentage of colon cancer cases with ≥12 lymph nodes removed during resection and examined, 2010-2014

Percentage of colorectal cancer surgeries, by approach, 2010-2014 Results Percentage of colorectal cancer surgeries, by approach, 2010-2014 Goal: Increase rates of laparoscopic surgery for colon cancer in Manitoba by 10% by March 2020

Quality Improvement Projects Increase rates of laparoscopic surgery for colon cancer in Manitoba by 10% by March 2020 Increase rates of immediate reconstruction by 10% by March 2020 Decrease rates of axillary clearance among women with no nodal metastasis by 10% by March 2020

Quality Improvement Projects Increase rates of laparoscopic surgery for colon cancer in Manitoba by 10% by March 2020 Increase rates of immediate reconstruction by 10% by March 2020 Decrease rates of axillary clearance among women with no nodal metastasis by 10% by March 2020 Action Plan: Increase capacity among rural and community sites to provide laparoscopic colon cancer surgery Needs assessment to understand learning needs Environmental scan to understand current case volume, infrastructure capacity etc. Mentorship plan and training opportunities based on a hub and spoke model Implement a quality improvement strategy to support the uptake of high-quality laparoscopic surgery Establish a formal community of practice

Thank you!