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Journal of Gastrointestinal Surgery

, Volume 22, Issue 8, pp 1358–1364 | Cite as

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

  • Kathryn Jaap
  • Marcus Fluck
  • Marie Hunsinger
  • Jeffrey Wild
  • Tania Arora
  • Mohsen Shabahang
  • Joseph Blansfield
Original Article

Abstract

Importance

Management of pancreatic cancer is complex, requiring coordination of multiple providers. National Comprehensive Cancer Network guidelines, developed for standardization and quality improvement, recommend a multimodal approach.

Objective

This study analyzed national rates of compliance with National Comprehensive Cancer Network recommendations, assessed factors affecting compliance, and evaluated whether compliance with evidence-based guidelines improved overall survival.

Design

This is a retrospective review of adults diagnosed with pancreatic cancer entered into the National Cancer Database. Patients included had stage I and II pancreatic cancer, and complete data in the database. Patients were classified as compliant if they underwent both surgery and a second treatment modality (chemotherapy, radiation, or chemoradiation). Clinico-pathologic variables were analyzed using univariate and multivariate models to predict overall survival.

Setting

Hospital-based national study population.

Participants

Patients with stage I or II pancreatic cancer.

Main Outcomes and Measures

Compliance with National Comprehensive Cancer Network recommendations, factors affecting compliance, and overall survival based on compliance.

Results

A total of 52,450 patients were included; 19,272 patients (37%) were compliant. Patients were found to be most compliant in the 50–59-year-old range (49% complaint), with decreased compliance at the extremes of age. Male patients were more compliant than female patients (39 vs 34%, p < 0.0001). Caucasians were more compliant (39%) than African Americans (32%) or other races (32%, p < 0.0001). Patients treated at academic/research centers were more compliant than patients treated at other facilities (39% compliant, p < 0.0001). Patients with stage II disease were more compliant compared with stage I disease (43 vs 18%, p < 0.0001). Compliance was shown to improve overall survival (p < 0.0001).

Conclusion

Adherence to National Comprehensive Cancer Network guidelines for pancreatic cancer patients improves survival. Compliance nationwide is low, especially for older patients and minorities and those treated outside academic centers. More studies will need to be performed to identify factors that hinder compliance.

Keywords

Compliance Pancreatic cancer 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors are all affiliated with Geisinger Medical Center, Danville, PA. The authors declare that they have no conflicts of interest.

References

  1. 1.
    Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin. 2017 67(1):7–30.CrossRefPubMedGoogle Scholar
  2. 2.
    Kooby DA, Gillespie TW, Liu Y, Byrd-Sellers J, Landry J, Bian J, et al. Impact of adjuvant radiotherapy on survival after pancreatic cancer resection: an appraisal of data from the national cancer data base. Annals of Surgical Oncology. 2013 20 (11):3634–42.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004 350(12):1200–10.CrossRefPubMedGoogle Scholar
  4. 4.
    Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA. 2007 297(3):267–77.CrossRefPubMedGoogle Scholar
  5. 5.
    Visser BC, Ma Y, Zak Y, Poultsides GA, Norton JA, Rhoads KF. Failure to comply with NCCN guidelines for the management of pancreatic cancer compromises outcomes. HPB. 2012 14(8):539–47.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    National Comprehensive Cancer Network Guidelines in Oncology. Pancreatic adenocarcinoma. Version 2.2016. www.nccn.org.
  7. 7.
    Akahori T, Sho M, Tanaka T, Kinoshita S, Nagai M, Nishiwada S, et al. Factors associated with failure to complete adjuvant chemotherapy in pancreatic cancer. Am J Surg. 2016 211(4):787–92.CrossRefPubMedGoogle Scholar
  8. 8.
    Stephens MR, Lewis WG, Brewster AE, Lord I, Blackshaw GR, Hodzovic I, et al. Multidisciplinary team management is associated with improved outcomes after surgery for esophageal cancer. Dis Esophagus. 2006; 19(3):164–71.CrossRefPubMedGoogle Scholar
  9. 9.
    Wille-Jorgensen P, Sparre P, Glenthoj A, Holck S, Norgaard Petersen L, Harling H, et al. Result of the implementation of multidisciplinary teams in rectal cancer. Colorectal Dis. 2013 15(4):410–3.CrossRefPubMedGoogle Scholar
  10. 10.
    Swan RZ, Lau KN, Sindram D, Iannitti DA, Martinie JB. Pancreatic resection in a large tertiary care community-based hospital: building a successful pancreatic surgery program. Surg Oncol Clin N Am. 2011 20(3):487,500, viii.Google Scholar
  11. 11.
    Erickson Foster J, Velasco JM, Hieken TJ. Adverse outcomes associated with noncompliance with melanoma treatment guidelines. Ann Surg Oncol. 2008 15(9):2395–402.CrossRefPubMedGoogle Scholar
  12. 12.
    Lewis CM, Hessel AC, Roberts DB, Guo YZ, Holsinger FC, Ginsberg LE, et al. Prereferral head and neck cancer treatment: compliance with national comprehensive cancer network treatment guidelines. Arch Otolaryngol Head Neck Surg. 2010 136(12):1205–11.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    O'Grady MA, Slater E, Sigurdson ER, Meropol NJ, Weinstein A, Lusch CJ, et al. Assessing compliance with national comprehensive cancer network guidelines for elderly patients with stage III colon cancer: the Fox Chase Cancer Center Partners’ initiative. Clin Colorectal Cancer. 2011 10(2):113–6.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Worhunsky DJ, Ma Y, Zak Y, Poultsides GA, Norton JA, Rhoads KF, et al. Compliance with gastric cancer guidelines is associated with improved outcomes. J Natl Compr Canc Netw. 2015 13(3):319–25.CrossRefPubMedGoogle Scholar
  15. 15.
    van Rijssen LB, van der Geest LG, Bollen TL, Bruno MJ, van der Gaast A, Veerbeek L, et al. National compliance to an evidence-based multidisciplinary guideline on pancreatic and periampullary carcinoma. Pancreatology. 2016 16(1):133–7.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  1. 1.Department of General SurgeryGeisinger Medical CenterDanvilleUSA

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