Evaluating disparities in delivery of neoadjuvant guideline‐based chemoradiation for rectal cancer: A multicenter, propensity score‐weighted cohort study

Abstract

Background Despite guideline recommendations, some patients still receive care inappropriate for their clinical stage of disease. Identification of factors that contribute to variation in guideline base care may help eradicate disparities in the treatment of early and locally advanced rectal cancer. Methods The American College of Surgeons National Cancer Database from 2010 to 2015 was analyzed with propensity score weighting to identify factors associated with delivery and omission of neoadjuvant guideline‐based chemoradiation (GBC) for those with early and locally advanced rectal cancer. Results Only 74% of patients with rectal cancer received stage‐appropriate neoadjuvant chemoradiation; 4544 (88%) of those with early stage disease and 8675 (68%) in locally advanced disease. Chemotherapy and radiotherapy were not planned in 27% and 34% respectively, of those who did not receive GBC. Factors associated with receipt of non‐guideline‐based neoadjuvant chemoradiation were age >65 years, Medicare insurance, treatment at a community facility, West‐South‐Central geography, having locally advanced disease, and Charlson–Deyo score >3. Receipt of ideal guideline‐based neoadjuvant chemoradiation conferred a survival benefit at 5 years. Conclusion Patient and non‐patient factors contribute to disparities in guideline‐based delivery of neoadjuvant chemoradiation in the treatment of rectal cancer. Identification of these risk factors are important to help standardize care and improve survival outcomes

Application Value of High-Quality Nursing in Operating Room in Rectal Cancer Operation and its Influence on Postoperative Rehabilitation

“…6 With the improvement of medical level and living standards of residents, and the continuous development of surgical operations, the requirements for perioperative care quality for patients with rectal cancer have increased significantly. 7 In addition, some clinical researches have clearly pointed out 8 that carrying out scientific and reasonable nursing intervention in the operating room for patients undergoing rectal cancer surgery can decrease the physical and mental stress responses of patients, and ensure that the operation can be carried out smoothly.…”

Guideline- Versus Non-Guideline-Based Neoadjuvant Management of Clinical T4 Rectal Cancer

“…Factors affecting guideline uptake would also include patient education, health insurance status, household income, etc. In addition, there may be sociological factors such as the convenience of off-site access for patients, whether there is adequate understanding and support for neoadjuvant treatment options [16,17].…”

Impact of Care Coordination on the Content of Communication Between Surgeons and Patients With Rectal Cancer

“… 5 – 8 Importantly, survival at 5 years approaches 75% for patients who receive guideline-recommended care but drops substantially for patients who do not receive this standard. 1 , 7 , 9 …”