Analyzing the Impact of Compliance with National Guidelines for Pancreatic Cancer Care Using the National Cancer Database

Jaap, Kathryn; Fluck, Marcus; Hunsinger, Marie; Wild, Jeffrey; Arora, Tania K.; Shabahang, Mohsen; Blansfield, Joseph

doi:10.1007/s11605-018-3742-9

Cited by 34 publications

(27 citation statements)

References 14 publications

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“…Our data confirm that it is an indirect measure of quality. The rate of compliance with the receipt of any adjunctive therapy (81% by 2015) is significantly higher than rates in similar studies in pancreatic cancer, but it is similar to prior NCDB reports of stage I to III gastric cancer (chemotherapy, 52%; radiation, 36%) . In light of the often cited 17‐year lag for the adoption of research into clinical practice, the adoption rates seen in this series appear reasonable, especially when we consider that some patients may either decline chemotherapy or not be candidates.…”

Section: Discussionsupporting

confidence: 78%

Integrated cancer networks improve compliance with national guidelines and outcomes for resectable gastric cancer

Thiels

Hanson

Habermann

et al. 2019

Cancer

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Background National Comprehensive Cancer Network (NCCN) guidelines recommend accurate clinical staging, perioperative therapy, and complete lymphadenectomy for patients with stage II to III gastric cancer. However, national compliance remains low. It was hypothesized that integrated cancer networks might improve compliance and outcomes within the community. Methods Patients with stage II to III gastric adenocarcinoma undergoing curative‐intent resection (National Cancer Data Base, 2006‐2015) were examined. Guideline compliance was defined as any perioperative adjunctive therapy, complete lymphadenectomy, complete clinical staging, and complete compliance (all measures). Univariate comparisons and multivariable regression were used to assess factors associated with compliance, and Kaplan‐Meier analysis was used to assess survival. Results There were 27,210 patients identified: 7235 (26.6%) underwent surgery alone, whereas 19,975 (73.4%) received additional therapy. Half (53.1%) had complete lymphadenectomies, whereas complete clinical staging was available for 65.5%. Overall compliance with all 3 measures was 30.1%. Compliance improved by approximately 20% for each measure across the 10‐year study period. Although patients treated at academic programs were most likely to receive concordant care in an adjusted analysis, those treated at integrated care networks were more likely to receive guideline‐concordant care (odds ratio [OR], 0.69) than those treated at comprehensive community programs (OR, 0.48) or community programs (OR, 0.45; all P values <.001). The median overall survival was 45.5 months for patients who received guideline‐concordant care and 32.0 months for those who did not (P < .001, reference for all ORs: academic programs). Conclusions Compliance with guidelines was associated with improved outcomes. Although the rate of compliance with NCCN guidelines is improving, integrated care networks may be an important way of improving the quality of gastric cancer care within the community.

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Section: Discussionsupporting

confidence: 78%

Integrated cancer networks improve compliance with national guidelines and outcomes for resectable gastric cancer

Thiels

Hanson

Habermann

et al. 2019

Cancer

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“…A retrospective analysis of the Nationwide Inpatient Sample from 2000 to 2005 demonstrated that access to high‐volume cancer centers for patients with pancreatic cancer was associated with race, with African–Americans, Hispanics, and Asians less often referred to these centers 46 . Lastly, recent studies have confirmed racial differences in surgical referral rates, patient compliance, and adherence to NCCN guidelines for patients of minorities and patients treated in the community setting, which could certainly affect overall survival outcomes 45,47 …”

Section: Discussionmentioning

confidence: 99%

Thirty‐day complication rates do not differ by race among patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma

Mitsakos

Dennis

Parikh

et al. 2021

Journal of Surgical Oncology

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Background and Objectives Black patients with pancreatic ductal adenocarcinoma (PDAC) are less likely to receive multimodality treatment and have worse survival compared to White patients. However, little is known regarding racial differences in postoperative outcomes. The primary aim of this study was to determine if 30‐day complication rates following pancreaticoduodenectomy (PD) differ by race. Methods A retrospective cohort study of patients who underwent PD for PDAC from 2014 to 2016 within the ACS‐NSQIP pancreatectomy‐specific data set was performed. Primary outcomes were 30‐day pancreas‐specific and overall major complications. Results A total of 6936 patients were identified, including 91.4% (N = 6337) White and 8.6% (N = 599) Black. Pathologic stage and rates of neoadjuvant therapy were similar among Whites and Blacks. Rates of pancreas‐specific (23.9% vs. 23.1%, p = .88) and major postoperative complications (39.2% vs. 39.9%, p = .55) were similar between Whites and Blacks. By multivariable regression analysis, there was no association between race and odds of pancreas‐specific complications (odds ratio [OR] 1.10, 95% confidence interval [CI] 0.89–1.37) or overall major complications (OR 1.13, 95% CI 0.95–1.36). Conclusions Among patients undergoing PD for PDAC, Black race is not associated with increased pancreas‐specific or overall 30‐day postoperative complications. Short‐term postoperative outcomes do not appear to explain the increase in pancreatic cancer mortality among Black patients.

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“…The National Comprehensive Cancer Network (NCCN) guidelines were created to provide clinical practice guidelines for common cancers, with regards to diagnosis, treatment and palliation. These guidelines were developed to standardize care as a means of quality improvement and have been shown to improve survival when guidelines are followed in other cancers 9,10 . Compliance with NCCN guidelines has also been shown to improve survival for gastric cancer in a study using the California Cancer Registry 11 .…”

Section: Compliance With National Guidelinesmentioning

confidence: 99%

MAGIC versus MacDonald treatment regimens for gastric cancer: Trends and predictors of multimodal therapy for gastric cancer using the National Cancer Database

Jayanathan

Erwin

Molacek

et al. 2020

The American Journal of Surgery

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Analyzing the Impact of Compliance with National Guidelines for Pancreatic Cancer Care Using the National Cancer Database

Cited by 34 publications

References 14 publications

Integrated cancer networks improve compliance with national guidelines and outcomes for resectable gastric cancer

Integrated cancer networks improve compliance with national guidelines and outcomes for resectable gastric cancer

Thirty‐day complication rates do not differ by race among patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma

MAGIC versus MacDonald treatment regimens for gastric cancer: Trends and predictors of multimodal therapy for gastric cancer using the National Cancer Database

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