Care Pathways Deliver Improved Survival in Populations with Colon Cancer

Background - Causes of variations in outcomes from cancer care in developed countries are often unclear and multifactorial. The pathways by which a patient travels to access health care services and the impact of health as a system on outcomes is not well understood. In this study, we sought to understand what factors within health system pathways influenced outcomes by measuring clinical care compliance with an evidenced-based pathway - the Optimal Care Pathway (OCP). The OCP is a framework outlining standards of care from pre-diagnosis to end-of-life care. Methods - Colon patients diagnosed from 2008-14 were identified from the Australian State of Victoria Cancer Registry (VCR) and cases linked with State and Federal health datasets. The impact of pathway deviations on outcomes was estimated. Findings- Compliance with the prevention phase of the OCP occurred for 88% of 13,539 individuals and was associated with lower disease stage at diagnosis (OR = 0.33 [95% CI = 0.24 - 0.42]), improved three year survival (69.2% vs 62.2%; p<0.001) and reduced likelihood of emergency surgery (17.7% versus 25.6%, p<0.001). For patients treated first with surgery (n=10,807), compliance with the diagnosis and treatment phase indicators (44% of patients) conferred a (risk-adjusted) survival benefit (HR=1.49 [95% CI = 1.28-1.73]), better perioperative outcomes, comparable costs and higher compliance to follow-up and end-of-life care. Interpretation - This high-income population-based study provides new evidence that adherence to evidence-based pathways within a whole systems approach is crucial for improving cancer outcomes. Funding Statement - The authors declare: None. Declaration of Interests - All authors declare no competing interests. Ethics Approval Statement - The Australian Institute of Health and Welfare Ethics Committee approved (Approval EO2015/4/219) the use of linked, routinely collected State and Federal datasets for the study of Victorians diagnosed with colon cancer (ICD-10-AM diagnosis codes C18) between 2008 and 2014 through the Victorian Cancer Registry (VCR).