The Canadian Partnership Against Cancer Rectal Cancer Project: Protocol for a Pan-Canadian, Multidisciplinary Quality Improvement Initiative to Optimize the Quality of Rectal Cancer Care

doi:10.2196/15535

. 2020 Jan 29;9(1):e15535.

doi: 10.2196/15535.

The Canadian Partnership Against Cancer Rectal Cancer Project: Protocol for a Pan-Canadian, Multidisciplinary Quality Improvement Initiative to Optimize the Quality of Rectal Cancer Care

Amandeep Pooni^{1

2

3}, Selina Schmocker³, Carl Brown⁴, Anthony MacLean⁵, Lara Williams⁶, Nancy N Baxter^{2

7}, Marko Simunovic⁸, Alexander Sender Liberman⁹, Sebastien Drolet¹⁰, Katerina Neumann¹¹, Kartik Jhaveri^{2

12}, Richard Kirsch^{2

13}, Erin Diane Kennedy^{1

2

3}

Affiliations

¹ Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.
² Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
³ Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada.
⁴ Department of Surgery, St Paul's Hospital, Vancouver, BC, Canada.
⁵ Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
⁶ Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
⁷ Department of Surgery and Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
⁸ Department of Surgery, McMaster Universtiy, Hamilton, ON, Canada.
⁹ Department of Surgery, McGill University, Montreal, QC, Canada.
¹⁰ Department of Surgery, Université Laval, Quebec City, QC, Canada.
¹¹ Department of Surgery, Queen Elizabeth II Health Sciences Centre, Victoria General Site, Halifax, NS, Canada.
¹² Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, Toronto, ON, Canada.
¹³ Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada.

PMID: 32012108
PMCID: PMC7016615
DOI: 10.2196/15535

The Canadian Partnership Against Cancer Rectal Cancer Project: Protocol for a Pan-Canadian, Multidisciplinary Quality Improvement Initiative to Optimize the Quality of Rectal Cancer Care

Amandeep Pooni et al. JMIR Res Protoc. 2020.

. 2020 Jan 29;9(1):e15535.

doi: 10.2196/15535.

Authors

Affiliations

¹ Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.
² Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
³ Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada.
⁴ Department of Surgery, St Paul's Hospital, Vancouver, BC, Canada.
⁵ Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
⁶ Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
⁷ Department of Surgery and Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
⁸ Department of Surgery, McMaster Universtiy, Hamilton, ON, Canada.
⁹ Department of Surgery, McGill University, Montreal, QC, Canada.
¹⁰ Department of Surgery, Université Laval, Quebec City, QC, Canada.
¹¹ Department of Surgery, Queen Elizabeth II Health Sciences Centre, Victoria General Site, Halifax, NS, Canada.
¹² Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, Toronto, ON, Canada.
¹³ Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada.

PMID: 32012108
PMCID: PMC7016615
DOI: 10.2196/15535

Abstract

Background: Over the last 2 decades, the use of multimodal strategies, including total mesorectal excision (TME) surgery, preoperative chemotherapy, multidisciplinary case conference, pelvic magnetic resonance imaging, and pathologic assessment using Quirke method, has led to significant improvements in oncologic outcomes for patients with rectal cancer. Although the literature supports claims on the effectiveness of these multimodal strategies, the uptake of these multimodal strategies varies considerably among centers, suggesting that the best evidence is not always implemented into clinical practice.

Objective: This study aims to perform a quality improvement initiative to (1) identify existing gaps in care for these multimodal strategies and (2) implement knowledge translation (KT) interventions to close these gaps to optimize quality of care for patients with rectal cancer across high-volume centers in Canada.

Methods: Process indicators for the selected multimodal strategies to optimize rectal cancer care will be selected and prospectively collected for all patients with stages 1 to 3 rectal cancer undergoing TME surgery. KT interventions, including audit and feedback, opinion leaders, and community of practice, will be implemented to increase the uptake of these clinical strategies.

Results: The uptake of the process indicators over time and the effect of the uptake of the process indicators on short- and long-term oncologic outcomes will be evaluated for each multimodal strategy.

Conclusions: This quality improvement initiative will identify existing gaps in care for the selected multimodal strategies and implement KT interventions to close these gaps. The results of this study will inform further efforts to optimize rectal cancer care.

International registered report identifier (irrid): DERR1-10.2196/15535.

Keywords: knowledge translation; quality improvement; rectal cancer.

©Amandeep Pooni, Selina Schmocker, Carl Brown, Anthony MacLean, Lara Williams, Nancy N Baxter, Marko Simunovic, Alexander Sender Liberman, Sebastien Drolet, Katerina Neumann, Kartik Jhaveri, Richard Kirsch, Erin Diane Kennedy. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 29.01.2020.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

**Figure 1**
Study overview. CoP: community of practice.

See this image and copyright information in PMC

Cited by

Knowledge Translation Interventions to Address Gaps in Rectal Cancer Care.
Kennedy ED, Pooni A, Schmocker S, Brown C, MacLean A, Baxter NN, Williams L, Simunovic M, Liberman S, Drolet S, Neumann K, Jhaveri K, Kirsch R. Kennedy ED, et al. JAMA Netw Open. 2025 Feb 3;8(2):e2461047. doi: 10.1001/jamanetworkopen.2024.61047. JAMA Netw Open. 2025. PMID: 39960667 Free PMC article.

References

1. Maurer CA, Renzulli P, Kull C, Käser SA, Mazzucchelli L, Ulrich A, Büchler MW. The impact of the introduction of total mesorectal excision on local recurrence rate and survival in rectal cancer: long-term results. Ann Surg Oncol. 2011 Jul;18(7):1899–906. doi: 10.1245/s10434-011-1571-0. - DOI - PubMed
1. Berardi R, Maccaroni E, Onofri A, Morgese F, Torniai M, Tiberi M, Ferrini C, Cascinu S. Locally advanced rectal cancer: the importance of a multidisciplinary approach. World J Gastroenterol. 2014 Dec 14;20(46):17279–87. doi: 10.3748/wjg.v20.i46.17279. http://www.wjgnet.com/1007-9327/full/v20/i46/17279.htm - DOI - PMC - PubMed
1. Peeters KC, Marijnen CA, Nagtegaal ID, Kranenbarg EK, Putter H, Wiggers T, Rutten H, Pahlman L, Glimelius B, Leer JW, van de Velde CJ, Dutch Colorectal Cancer Group The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg. 2007 Nov;246(5):693–701. doi: 10.1097/01.sla.0000257358.56863.ce. - DOI - PubMed
1. Wong RK, Berry S, Spithoff K, Simunovic M, Chan K, Agboola O, Dingle B, Gastrointestinal Cancer Disease Site Group Preoperative or postoperative therapy for stage II or III rectal cancer: an updated practice guideline. Clin Oncol (R Coll Radiol) 2010 May;22(4):265–71. doi: 10.1016/j.clon.2010.03.002. - DOI - PubMed
1. Monson JR, Weiser MR, Buie WD, Chang GJ, Rafferty JF, Buie WD, Rafferty J, Standards Practice Task Force of the American Society of Colon and Rectal Surgeons Practice parameters for the management of rectal cancer (revised) Dis Colon Rectum. 2013 May;56(5):535–50. doi: 10.1097/DCR.0b013e31828cb66c. - DOI - PubMed

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[1] Maurer CA, Renzulli P, Kull C, Käser SA, Mazzucchelli L, Ulrich A, Büchler MW. The impact of the introduction of total mesorectal excision on local recurrence rate and survival in rectal cancer: long-term results. Ann Surg Oncol. 2011 Jul;18(7):1899–906. doi: 10.1245/s10434-011-1571-0. - DOI - PubMed

[2] Maurer CA, Renzulli P, Kull C, Käser SA, Mazzucchelli L, Ulrich A, Büchler MW. The impact of the introduction of total mesorectal excision on local recurrence rate and survival in rectal cancer: long-term results. Ann Surg Oncol. 2011 Jul;18(7):1899–906. doi: 10.1245/s10434-011-1571-0. - DOI - PubMed

[3] Berardi R, Maccaroni E, Onofri A, Morgese F, Torniai M, Tiberi M, Ferrini C, Cascinu S. Locally advanced rectal cancer: the importance of a multidisciplinary approach. World J Gastroenterol. 2014 Dec 14;20(46):17279–87. doi: 10.3748/wjg.v20.i46.17279. http://www.wjgnet.com/1007-9327/full/v20/i46/17279.htm - DOI - PMC - PubMed

[4] Berardi R, Maccaroni E, Onofri A, Morgese F, Torniai M, Tiberi M, Ferrini C, Cascinu S. Locally advanced rectal cancer: the importance of a multidisciplinary approach. World J Gastroenterol. 2014 Dec 14;20(46):17279–87. doi: 10.3748/wjg.v20.i46.17279. http://www.wjgnet.com/1007-9327/full/v20/i46/17279.htm - DOI - PMC - PubMed

[5] Peeters KC, Marijnen CA, Nagtegaal ID, Kranenbarg EK, Putter H, Wiggers T, Rutten H, Pahlman L, Glimelius B, Leer JW, van de Velde CJ, Dutch Colorectal Cancer Group The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg. 2007 Nov;246(5):693–701. doi: 10.1097/01.sla.0000257358.56863.ce. - DOI - PubMed

[6] Peeters KC, Marijnen CA, Nagtegaal ID, Kranenbarg EK, Putter H, Wiggers T, Rutten H, Pahlman L, Glimelius B, Leer JW, van de Velde CJ, Dutch Colorectal Cancer Group The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg. 2007 Nov;246(5):693–701. doi: 10.1097/01.sla.0000257358.56863.ce. - DOI - PubMed

[7] Wong RK, Berry S, Spithoff K, Simunovic M, Chan K, Agboola O, Dingle B, Gastrointestinal Cancer Disease Site Group Preoperative or postoperative therapy for stage II or III rectal cancer: an updated practice guideline. Clin Oncol (R Coll Radiol) 2010 May;22(4):265–71. doi: 10.1016/j.clon.2010.03.002. - DOI - PubMed

[8] Wong RK, Berry S, Spithoff K, Simunovic M, Chan K, Agboola O, Dingle B, Gastrointestinal Cancer Disease Site Group Preoperative or postoperative therapy for stage II or III rectal cancer: an updated practice guideline. Clin Oncol (R Coll Radiol) 2010 May;22(4):265–71. doi: 10.1016/j.clon.2010.03.002. - DOI - PubMed

[9] Monson JR, Weiser MR, Buie WD, Chang GJ, Rafferty JF, Buie WD, Rafferty J, Standards Practice Task Force of the American Society of Colon and Rectal Surgeons Practice parameters for the management of rectal cancer (revised) Dis Colon Rectum. 2013 May;56(5):535–50. doi: 10.1097/DCR.0b013e31828cb66c. - DOI - PubMed

[10] Monson JR, Weiser MR, Buie WD, Chang GJ, Rafferty JF, Buie WD, Rafferty J, Standards Practice Task Force of the American Society of Colon and Rectal Surgeons Practice parameters for the management of rectal cancer (revised) Dis Colon Rectum. 2013 May;56(5):535–50. doi: 10.1097/DCR.0b013e31828cb66c. - DOI - PubMed

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The Canadian Partnership Against Cancer Rectal Cancer Project: Protocol for a Pan-Canadian, Multidisciplinary Quality Improvement Initiative to Optimize the Quality of Rectal Cancer Care

Affiliations

The Canadian Partnership Against Cancer Rectal Cancer Project: Protocol for a Pan-Canadian, Multidisciplinary Quality Improvement Initiative to Optimize the Quality of Rectal Cancer Care

Authors

Affiliations

Abstract

Conflict of interest statement

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Abstract

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