Surgeon-Level Variation in Utilization of Local Staging and Neoadjuvant Therapy for Stage II-III Rectal Adenocarcinoma

Swords, Douglas S.; Skarda, David E.; Sause, William T.; Gawlick, Ute; Cannon, George M.; Lewis, Mark A.; Scaife, Courtney L.; Gygi, Jesse; Kim, H. Tae

doi:10.1007/s11605-019-04107-1

Cited by 10 publications

(13 citation statements)

References 35 publications

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“…Prior studies also note that nGBC may be administered when preoperative staging is missing or incomplete. Swords et al 8 found that omission of local staging contributed to a 17‐fold increased risk of not receiving appropriate neoadjuvant chemoradiation. To remove the influence of incomplete local staging on delivery of GBC, our study excluded patients who did not have preoperative local staging data present and still found that 26% of the patients did not receive GBC.…”

Section: Discussionmentioning

confidence: 99%

“…Past studies have focused on identifying factors associated with nonadherence to guidelines in the management of rectal cancer 1,3,5–7 . Lack of local staging, facility type, and comorbidities have been associated with the omission of guideline‐based neoadjuvant chemoradiation for locally advanced rectal adenocarcinoma 1,6,8 . However, a number of these studies exclude early stage (T1–2 N0) disease in their analysis 1,4,8,9 .…”

Section: Introductionmentioning

confidence: 99%

“…Lack of local staging, facility type, and comorbidities have been associated with the omission of guideline‐based neoadjuvant chemoradiation for locally advanced rectal adenocarcinoma 1,6,8 . However, a number of these studies exclude early stage (T1–2 N0) disease in their analysis 1,4,8,9 . Identifying factors contributing to the deviation from GBC in relation to final patient outcome will help optimize treatment and guideline adherence for both early and locally advanced rectal cancer.…”

Section: Introductionmentioning

confidence: 99%

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

Lau

Kethman

Bingmer

et al. 2021

Journal of Surgical Oncology

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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

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Lau

Kethman

Bingmer

et al. 2021

Journal of Surgical Oncology

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“…2,4,5 Nevertheless, despite clear guidelines, NT is not administered consistently in the United States, resulting in poorer survival for patients in whom NT is omitted. [6][7][8] Standardized care by a multidisciplinary team is the key "best practice" promoted by the American College of Surgeons Commission on Cancer's National Accreditation Program for Rectal Cancer (NAPRC). [9][10][11] Surgeons and other physicians must consistently recognize when a patient has mid-to-low RC and should perform local RC staging for these cases.…”

Section: Pacientesmentioning

confidence: 99%

Lack of Complete Pretreatment Staging Is Associated With Omission of Neoadjuvant Therapy for Rectal Cancer: A Statewide Study

Tang

Rivard

Weng

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Standardized local staging and neoadjuvant therapy are rectal cancer management quality measures supported by the Commission on Cancer and National Accreditation Program for Rectal Cancer for the management of rectal cancer. Previous studies suggested that up to 25% of patients with stage II/III rectal cancer patients do not receive neoadjuvant therapy. We hypothesized that failure to receive neoadjuvant therapy may be caused by failure to properly stage patients before surgery. OBJECTIVE: This study aimed to determine whether lack of local rectal cancer staging is associated with underutilization of neoadjuvant therapy and to determine risk factors for omission of neoadjuvant therapy. DESIGN: Retrospective cohort study. Bivariate and multivariable analyses were performed on patient, tumor, and 30-day outcome factors associated with neoadjuvant therapy and staging. SETTINGS: hospitals participated in the Michigan Surgical Quality Collaborative Colorectal Cancer Project from January 2014 to December 2019. PATIENTS: Elective, clinical stage II/III, mid-to-low rectal cancer resections. Patients with upper rectal cancer were excluded. MAIN OUTCOME MEASURES: Percentage of patients receiving neoadjuvant therapy. RESULTS: The final cohort included 350 patients with clinical stage II/III mid or low rectal cancer—80.9% of patients who had received neoadjuvant therapy and 83.2% of patients who had MRI and/or endoscopic ultrasound. A significant association was found between receiving neoadjuvant therapy and MRI/endorectal ultrasound staging (p < 0.0001). Eighty-seven percent of patients who had MRI/endorectal ultrasound received neoadjuvant chemoradiotherapy; 49% of patients who did not have MRI/endorectal ultrasound staging received neoadjuvant chemoradiotherapy. Multivariate analysis revealed that risk factors for the omission of neoadjuvant therapy were older age and incomplete staging. LIMITATIONS: Observational study with the possibility of unmeasured confounding variables. CONCLUSIONS: Neoadjuvant therapy is underused in patients with stage II/III rectal cancer. Omission of pretreatment staging with MRI/endorectal ultrasound is associated with omission of neoadjuvant therapy. These data suggest the need for regional and national quality improvement strategies to standardize the multidisciplinary management of rectal cancer. See Video Abstract at http://links.lww.com/DCR/B923. LA FALTA DE ESTADIFICACIÓN COMPLETA PREVIA AL TRATAMIENTO SE ASOCIA CON LA OMISIÓN DE LA TERAPIA NEOADYUVANTE PARA EL CÁNCER DE RECTO: UN ESTUDIO ESTATAL ANTECEDENTES: La estadificación local estandarizada y la terapia neoadyuvante son medidas de calidad de la Comisión sobre el Cáncer y el Programa Nacional de Acreditación para el Cáncer de Recto para el tratamiento del cáncer de recto. Estudios previos sugirieron que hasta el 25% de los pacientes con cáncer de recto en estadio II/III no reciben terapia neoadyuvante. Planteamos la hipótesis de que la falla en recibir la terapia neoadyuvante puede deberse a la falla...

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“…These clinical processes and strategies have been widely supported in the literature and have led to improved patient outcomes. However, their implementation has been challenging, with several studies from North America and Europe demonstrating considerable variation in their uptake across clinical practice [16,[28][29][30][31][32][33][34][35][36][37][38].…”

Section: Introductionmentioning

confidence: 99%

Quality indicator selection for the Canadian Partnership against Cancer rectal cancer project: A modified Delphi study

et al. 2021

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Aim: It is well established that (i) magnetic resonance imaging, (ii) multidisciplinary cancer conference (MCCs), (iii) preoperative radiotherapy, (iv) total mesorectal excision surgery and (v) pathological assessment as described by Quirke are key processes necessary for high quality, rectal cancer care. The objective was to select a set of multidisciplinary quality indicators to measure the uptake of these clinical processes in clinical practice. Method: A multidisciplinary panel was convened and a modified two-phase Delphi method was used to select a set of quality indicators. Phase 1 included a literature review with written feedback from the panel. Phase 2 included an in-person workshop with anonymous voting. The selection criteria for the indicators were strength of evidence, ease of capture and usability. Indicators for which ≥90% of the panel members voted 'to keep' were selected as the final set of indicators. Results: During phase 1, 68 potential indicators were generated from the literature and an additional four indicators were recommended by the panel. During phase 2, these 72 indicators were discussed; 48 indicators met the 90% inclusion threshold and included eight pathology, five radiology, 11 surgical, six radiation oncology and 18 MCC indicators.

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Surgeon-Level Variation in Utilization of Local Staging and Neoadjuvant Therapy for Stage II-III Rectal Adenocarcinoma

Cited by 10 publications

References 35 publications

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

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

Lack of Complete Pretreatment Staging Is Associated With Omission of Neoadjuvant Therapy for Rectal Cancer: A Statewide Study

Quality indicator selection for the Canadian Partnership against Cancer rectal cancer project: A modified Delphi study

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