FAQs - Fast Facts (Stage of Disease/Treatment)
Question: What is the relationship between stage of disease and recommended treatment for my patients with colorectal cancer (CRC)
Answer:Tumor staging is used by investigators and clinicians to group patients who have tumors with like characteristics into subgroups. Generally, grouping is according to tumor size and invasiveness, extent of disease, and evidence of spread to distant organs. There are many different staging systems; however, the system most commonly used in describing CRC is the Tumor, Nodes, Metastasis (TNM) system of the American Joint Committee on Cancer. Clinical trials testing the efficacy and safety of new agents, combinations of drugs, and multimodal therapies analyze study findings according to subgroups of patients with CRC, because there are differences in response, depending on extent of disease and various host factors. This approach helps physicians to base their recommendations on scientific evidence and to customize their treatment recommendations to the individual, thus ensuring that the patient will receive the best evidence-based therapy available given his or her particular clinical situation. The following is a summary of evidence-based National Comprehensive Cancer Network (NCCN) guidelines for the formulation of treatment recommendations for CRC1:
- Stage I: surgery alone.
- Stage II: surgery + consider 6 months of adjuvant chemotherapy or entry into clinical trial or observation alone; consideration of adjuvant chemotherapy is more strongly recommended for patients with high risk factors.
- Stage III: surgery + 6 months of adjuvant chemotherapy; if patient had resectable liver metastasis then add radiation therapy.
- Stage IV: surgery + chemotherapy with any of numerous regimens containing tested combinations of agents (5-FU/leucovorin, oxaliplatin, irinotecan, capecitabine, bevacizumab, cetuximab).
NCCN clinical guidelines and staging information are available on-line or in hard copy in both professional and patient versions and can be used to educate patients and families and to assist them in making treatment decisions.
Prescribing therapy based on established standards promises to become increasingly important and, in the future, is likely to be linked to reimbursement. Currently, the Centers for Medicare and Medicaid Services (CMS) is conducting a project to determine the correlation between prescribed therapy and established treatment guidelines for 13 different cancer diagnoses, and colon and rectal cancers comprise 2 of these. Known as the 2006 Oncology Demonstration Program: Improved Quality of Care for Cancer Patients Through More Effective Payments and Evidence-Based Care, this study asks physicians to2:
- Identify the primary focus of the evaluation and management service from one of several categories as defined by specific G codes provided by CMS.
- Report the status of their patient's cancer (eg, characterize the extent of spread of the cancer).
- Report whether the patient's treatment adheres to guidelines developed by the NCCN or the American Society of Clinical Oncology (ASCO).
References
- National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology: Colon Cancer, v.2.2006. Available at: http://www.nccn.org.
- Centers for Medicare and Medicaid Services. 2006 Oncology Demonstration Program: Improved Quality of Care for Cancer Patients Through More Effective Payments and Evidence-Based Care. Available at: http://www.cms.hhs.gov.
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