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

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

3. 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.

4. 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.

5. 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.

6. 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.

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

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

9. 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

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

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

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

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

14. Results
Percentage of colon cancer cases with ≥12 lymph nodes removed during resection and examined,

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

16. 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

17. 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

18. Thank you!