Adherence to Stage-Specific Treatment Guidelines for Patients With Colon Cancer

Abstract

Purpose Adherence to evidence-based treatment guidelines has been proposed as a measure of cancer care quality. We sought to determine rates of and factors associated with adherence to the National Comprehensive Cancer Network (NCCN) treatment guidelines for colon cancer. Patients and Methods Patients within the National Cancer Data Base treated for colon adenocarcinoma (2003 to 2007) were identified. Adherence to stage-specific NCCN guidelines was determined based on disease stage. Hierarchical regression analyses were performed to identify factors predictive of adherence, overtreatment, and undertreatment. Results A total of 173,243 patients were included in the final cohort, 123,953 (71%) of whom were treated according to NCCN guidelines. Patients with stage I disease were more likely to receive guideline-based treatment (96%) than patients with stage II (low risk, 66%; high risk, 36%), III (71%), or IV (73%) disease (P < .001). Adherence to consensus-based guidelines increased over time. Factors associated with adherence across all stages included age, Charlson-Deyo comorbidity index score, later year of diagnosis, and insurance status. Among patients with high-risk stage II or stage III disease, older patients with pre-existing comorbidities and patients with lower socioeconomic status were less likely to be offered adjuvant chemotherapy. Among patients with stage I and II disease, young, healthy patients were more likely to be recommended chemotherapy, in discordance with NCCN guidelines. Conclusion Significant variation exists in the treatment of colon cancer, particularly in treatment of high-risk stage II and stage III disease. The impact of nonadherence to guidelines on patient outcomes needs to be further elucidated.

Relative Effectiveness and Safety of Chemotherapy in Elderly and Nonelderly Patients With Stage III Colon Cancer: A Systematic Review

“…Recent studies have shown that older patients with stage III colon cancer, often with pre-existing comorbidities, were less likely to receive adjuvant chemotherapy, when the survival benefit was comparable across age groups [44,45].…”

Regional Variation in the Management of Metastatic Gastric Cancer in Ontario

“…Despite attempts to standardize practice, variations in the provision of gastric cancer care have been demonstrated for multiple health care system variables, especially between geographic regions and centres of care [29][30][31][32][33] . Geographic variation in practice patterns commonly occurs when accepted standards of care do not exist for a particular disease, or if resources are limited or unavailable and alternative approaches are required [1][2][3]5,32,34 . Even in the presence of clear recommendations for clinical care, uptake of clinical guidelines can be greatly influenced by geographic location and prevailing health care system characteristics 1,2 .…”

Comparative effectiveness of chemotherapy in elderly patients with metastatic colorectal cancer.

“…This presents a significant challenge to efforts to evaluate treatment efficacy and safety in elderly patients [22]. Furthermore, there is limited knowledge about the use of recommended newer agents for the treatment of mCRC in community settings, particularly for older and demographically diverse patient populations [23]. However, there is evidence to suggest variations in the management of patients with all stages of CRC with several studies reporting lower rates of chemotherapy for older patients [23][24][25][26][27] and almost 30 % of stage III and IV patients were less likely to receive guideline-recommended therapies [27].…”