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

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

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.

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Authors and Affiliations

  1. Department of General Surgery, Geisinger Medical Center, 100 N Academy Avenue, MC 21-69, Danville, PA, 17822, USA

    Kathryn Jaap, Marcus Fluck, Marie Hunsinger, Jeffrey Wild, Tania Arora, Mohsen Shabahang & Joseph Blansfield

Authors
  1. Kathryn Jaap
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  2. Marcus Fluck
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  3. Marie Hunsinger
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  4. Jeffrey Wild
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  5. Tania Arora
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  6. Mohsen Shabahang
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  7. Joseph Blansfield
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Corresponding author

Correspondence to Kathryn Jaap.

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Conflict of Interest

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

Additional information

Key Points

Question: What are the national rates of compliance with NCCN recommendations, what factors affect compliance, and does compliance with evidence-based guidelines improved overall survival (OS)?

Findings: In this retrospective review of a national database that included 52,450 patients, 37% of patients were compliance with guidelines and guideline compliance improved overall survival in this patient population in a significant fashion.

Meaning: Compliance to national guidelines is important when treating patients with pancreatic cancer.

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Jaap, K., Fluck, M., Hunsinger, M. et al. Analyzing the Impact of Compliance with National Guidelines for Pancreatic Cancer Care Using the National Cancer Database. J Gastrointest Surg 22, 1358–1364 (2018). https://doi.org/10.1007/s11605-018-3742-9

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  • DOI: https://doi.org/10.1007/s11605-018-3742-9

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