David J Worhunsky1, Yifei Ma2, Yulia Zak1, George A Poultsides1, Jeffrey A Norton1, Kim F Rhoads2, Brendan C Visser1. 1. From the Department of Surgery, Stanford University Medical Center, and Stanford Cancer Institute, Stanford, California. 2. From the Department of Surgery, Stanford University Medical Center, and Stanford Cancer Institute, Stanford, California. From the Department of Surgery, Stanford University Medical Center, and Stanford Cancer Institute, Stanford, California.
Abstract
BACKGROUND: Limited data are available on the implementation and effectiveness of NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Gastric Cancer. PURPOSE: We sought to assess rates of compliance with NCCN Guidelines, specifically stage-specific therapy during the initial episode of care, and to determine its impact on outcomes. METHODS: The California Cancer Registry was used to identify cases of gastric cancer from 2001 to 2006. Logistic regression and Cox proportional hazard models were used to predict guideline compliance and the adjusted hazard ratio for mortality. Patients with TNM staging or summary stage (SS) were also analyzed separately. RESULTS: Compliance with NCCN Guidelines occurred in just 45.5% of patients overall. Patients older than 55 years were less likely to receive guideline-compliant care, and compliance was associated with a median survival of 20 versus 7 months for noncompliant care (P<.001). Compliant care was also associated with a 55% decreased hazard of mortality (P<.001). Further analysis revealed that 50% of patients had complete TNM staging versus an SS, and TNM-staged patients were more likely to receive compliant care (odds ratio, 1.59; P<.001). TNM-staged patients receiving compliant care had a median survival of 25.3 months compared with 15.1 months for compliant SS patients. CONCLUSIONS: Compliance with NCCN Guidelines and stage-specific therapy at presentation for the treatment of patients with gastric cancer was poor, which was a significant finding given that compliant care was associated with a 55% reduction in the hazard of death. Additionally, patients with TNM-staged cancer were more likely to receive compliant care, perhaps a result of having received more intensive therapy. Combined with the improved survival among compliant TNM-staged patients, these differences have meaningful implications for health services research.
BACKGROUND: Limited data are available on the implementation and effectiveness of NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Gastric Cancer. PURPOSE: We sought to assess rates of compliance with NCCN Guidelines, specifically stage-specific therapy during the initial episode of care, and to determine its impact on outcomes. METHODS: The California Cancer Registry was used to identify cases of gastric cancer from 2001 to 2006. Logistic regression and Cox proportional hazard models were used to predict guideline compliance and the adjusted hazard ratio for mortality. Patients with TNM staging or summary stage (SS) were also analyzed separately. RESULTS: Compliance with NCCN Guidelines occurred in just 45.5% of patients overall. Patients older than 55 years were less likely to receive guideline-compliant care, and compliance was associated with a median survival of 20 versus 7 months for noncompliant care (P<.001). Compliant care was also associated with a 55% decreased hazard of mortality (P<.001). Further analysis revealed that 50% of patients had complete TNM staging versus an SS, and TNM-staged patients were more likely to receive compliant care (odds ratio, 1.59; P<.001). TNM-staged patients receiving compliant care had a median survival of 25.3 months compared with 15.1 months for compliant SS patients. CONCLUSIONS: Compliance with NCCN Guidelines and stage-specific therapy at presentation for the treatment of patients with gastric cancer was poor, which was a significant finding given that compliant care was associated with a 55% reduction in the hazard of death. Additionally, patients with TNM-staged cancer were more likely to receive compliant care, perhaps a result of having received more intensive therapy. Combined with the improved survival among compliant TNM-staged patients, these differences have meaningful implications for health services research.
Authors: A L Mahar; A El-Sedfy; M Dixon; M Siddiqui; M Elmi; A Ritter; J Vasilevska-Ristovska; Y Jeong; L Helyer; C Law; B Zagorski; N G Coburn Journal: Curr Oncol Date: 2018-10-31 Impact factor: 3.677
Authors: Abdul Rahman Jazieh; Khaled Al Kattan; Ahmed Bamousa; Ashwaq Al Olayan; Ahmed Abdelwarith; Jawaher Ansari; Abdullah Al Twairqi; Turki Al Fayea; Khalid Al Saleh; Hamed Al Husaini; Nafisa Abdelhafiez; Mervat Mahrous; Medhat Faris; Ameen Al Omair; Adnan Hebshi; Salem Al Shehri; Foad Al Dayel; Hanaa Bamefleh; Walid Khalbuss; Sarah Al Ghanem; Shukri Loutfi; Azzam Khankan; Meshael Al Rujaib; Majed Al Ghamdi; Nagwa Ibrahim; Abdulmonem Swied; Mohammad Al Kayait; Marie Datario Journal: Ann Thorac Med Date: 2017 Oct-Dec Impact factor: 2.219