NCCN guideline concordance in colon and rectal cancer patients within a comprehensive health system

초록

Background: The National Comprehensive Cancer Care Network (NCCN) provides recommendations for patients with colorectal cancer. Concordance with evidence-based guidelines improves outcomes. Our objectives were to 1) examine rates of guideline non-concordance in a large vertically integrated health system; 2) examine factors associated with non-concordant care, and 3) identify geographical patterns of non-concordant care. Methods: Colorectal cancer patients were identified from a single-state 16 hospital health-system cancer registry diagnosed between 2011 and 2021. We defined major (MAJ) and minor (MIN) quality indicators of guidelineconcordance based on NCCN guidelines. Regression methods were used to identify predictors of major quality criteria non-concordance. County-level mapping was used to identify geographical locations of the highest rates of non-concordance. Results: Overall, 2324 patients with colon and rectal cancer were analyzed. There was a complete guideline concordance (an absence of guideline non-concordance) rate of 24.7% (n = 573), MIN only guideline nonconcordance rate of 63.3% (n = 1471), and MAJ non-concordance rate of 12.4% (n = 280). Predictors of MAJ non-concordance for colon cancer were stage, >1 Charleson-Deyo Score, >60 days from diagnosis to treatment, and >1 hospital network used for care. Predictors of MAJ non-concordance for rectal cancer were >60 days from diagnosis to treatment, and >1 facility used for care. Marion county had the highest rates of non-concordance for colon and rectal cancer. Conclusion: The majority of colon and rectal cancer patients in a large health system received guideline concordant major quality indicators, however 12% of patients do not. An identifiable geographical location with the highest rates of non-concordance and its associated factors serves as a target for future quality improvement.

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