Alberta Rectal Cancer Initiative: Implementation of a Provincial Rectal Cancer Clinical Pathway Quality Improvement Project

Student Researcher:
Michael Taylor

Supervisors / Principle Investigators:
W. Donald Buie
Todd McMullen

MD Class of 2020


Background: A multi-disciplinary clinical pathway with discipline-specific goals was created. Following baseline data collection, stakeholders from radiology, oncology, surgery, and pathology were engaged to standardize care and inform reporting schemas. Education days with international experts were held to reinforce best practice, and synoptic reporting templates were developed.

Methodology: Quality indicators determining best practice adherence and oncologic outcomes were collated and reported. Pathology reports were used as quality assurance for surgical technique and MRI-staging. The appropriate use of neoadjuvant therapy was correlated with collaborative staging. These measures were then used to provide ongoing individualized audit/feedback reports to practitioners through a secure web-based portal; reports contain individual physician data and aggregate provincial data for each indicator to inform and improve practice.

Results: Compared to baseline (2010-2013), by 2015 there was a 14% increase in the use of preoperative staging MRI, provincially. Reporting also improved for essential elements on rectal staging MRI, including distance to mesorectal fascia (22 to 81%), extramural venous invasion (17 to 70%), relation to anal sphincter (29 to 78%), and relation to peritoneal reflection (6 to 64%). Surgical technique improved with 91% of rectal specimens graded as ‘complete’ or ‘near-complete’ and a margin positivity of 7% on pathology. Nearly all (94%) pathology reports were completed synoptically, with 90% reporting all mandatory data elements.

Conclusion: Implementation of a clinical pathway for rectal cancer has improved uptake of best practice across the clinical continuum; this sustainable multifaceted approach includes education, engagement, feedback reporting, and is easily adaptable to other tumor groups.