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. 2022 Mar 8;7(5):100938.
doi: 10.1016/j.adro.2022.100938. eCollection 2022 Sep-Oct.

Nonadherence to Multimodality Cancer Treatment Guidelines in the United States

Leila T Tchelebi  1   2 , Biyi Shen  3 , Ming Wang  3 , Louis Potters  1 , Joseph Herman  1 , Daniel Boffa  4 , Joel E Segel  5 , Henry S Park  6 , Nicholas G Zaorsky  7
Affiliations

Nonadherence to Multimodality Cancer Treatment Guidelines in the United States

Leila T Tchelebi et al. Adv Radiat Oncol. .

Abstract

Purpose: Our purpose was to identify patients with cancer who do not receive guideline-concordant multimodality treatment and to identify factors that are associated with nonreceipt of guideline-concordant multimodality treatment.

Methods and materials: Five cancers for which the multimodal guideline-concordant treatment (with surgery, chemotherapy, and radiation therapy) is clearly defined in national guidelines were selected from the National Cancer Database: (1) nonmetastatic anal cancer, (2) locally advanced cervical cancer, (3) nonmetastatic nasopharynx cancer, (4) locally advanced rectal cancer, and (5) locally advanced non-small cell lung cancer. Multivariable logistic regression was used to determine the odds ratios (with 95% confidence intervals) of receiving the guideline-concordant treatment versus not, adjusting for common confounding variables.

Results: 178,005 patients with cancer were included: 32,214 anal, 54,485 rectal, 13,179 cervical, 5061 nasopharyngeal, and 73,066 lung. Overall, 162,514 (91%) received guideline-concordant treatment and 15,491 (9%) did not. Twenty-one percent of patients with cervical cancer, 10% of patients with rectal cancer, 7% of patients with lung cancer, 5% of patients with anal cancer, and 3% of patients with nasopharynx cancer did not receive guideline-concordant treatment. In general, patients who were older, with comorbid conditions, and who were evaluated at low-volume facilities (odds ratios > 1 with P < .05) were less likely to receive guideline-concordant treatment.

Conclusions: Nearly 1 in 10 patients in this cohort are not receiving appropriate multimodal cancer therapy. There appear to be significant disparities in receipt of guideline-concordant treatment based on primary tumor site, age, comorbidities, and reporting facility.

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Figures

Fig 1
Fig. 1
Treatments delivered to patients. (A) Percent of patients receiving nonguideline-concordant therapy versus guideline-concordant therapy by disease site. (B) Percent of patients receiving specific nonguideline concordant treatments by disease site.
See this image and copyright information in PMC

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