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Integrated cancer networks improve compliance with national guidelines and outcomes for resectable gastric cancer.
Cancer ( IF 6.2 ) Pub Date : 2019-12-10 , DOI: 10.1002/cncr.32660 Cornelius A Thiels 1 , Kristine T Hanson 1 , Elizabeth B Habermann 1, 2, 3 , Judy C Boughey 2, 4 , Travis E Grotz 2, 4
Cancer ( IF 6.2 ) Pub Date : 2019-12-10 , DOI: 10.1002/cncr.32660 Cornelius A Thiels 1 , Kristine T Hanson 1 , Elizabeth B Habermann 1, 2, 3 , Judy C Boughey 2, 4 , Travis E Grotz 2, 4
Affiliation
BACKGROUND
National Comprehensive Cancer Network (NCCN) guidelines recommend accurate clinical staging, perioperative therapy, and complete lymphadenectomy for patients with stage II to III gastric cancer. However, national compliance remains low. It was hypothesized that integrated cancer networks might improve compliance and outcomes within the community.
METHODS
Patients with stage II to III gastric adenocarcinoma undergoing curative-intent resection (National Cancer Data Base, 2006-2015) were examined. Guideline compliance was defined as any perioperative adjunctive therapy, complete lymphadenectomy, complete clinical staging, and complete compliance (all measures). Univariate comparisons and multivariable regression were used to assess factors associated with compliance, and Kaplan-Meier analysis was used to assess survival.
RESULTS
There were 27,210 patients identified: 7235 (26.6%) underwent surgery alone, whereas 19,975 (73.4%) received additional therapy. Half (53.1%) had complete lymphadenectomies, whereas complete clinical staging was available for 65.5%. Overall compliance with all 3 measures was 30.1%. Compliance improved by approximately 20% for each measure across the 10-year study period. Although patients treated at academic programs were most likely to receive concordant care in an adjusted analysis, those treated at integrated care networks were more likely to receive guideline-concordant care (odds ratio [OR], 0.69) than those treated at comprehensive community programs (OR, 0.48) or community programs (OR, 0.45; all P values <.001). The median overall survival was 45.5 months for patients who received guideline-concordant care and 32.0 months for those who did not (P < .001, reference for all ORs: academic programs).
CONCLUSIONS
Compliance with guidelines was associated with improved outcomes. Although the rate of compliance with NCCN guidelines is improving, integrated care networks may be an important way of improving the quality of gastric cancer care within the community.
中文翻译:
综合性癌症网络提高了对可切除胃癌国家指南和结果的依从性。
背景技术国家综合癌症网络(NCCN)指南建议对II至III期胃癌患者进行准确的临床分期,围手术期治疗和完整的淋巴结清扫术。但是,国家合规性仍然很低。据推测,整合的癌症网络可能会改善社区内的依从性和结果。方法检查接受根治性切除的II至III期胃腺癌患者(国家癌症数据库,2006-2015)。指南的依从性定义为任何围手术期辅助治疗,彻底的淋巴结清扫术,完全的临床分期和完全依从性(所有措施)。单变量比较和多变量回归用于评估与依从性相关的因素,而Kaplan-Meier分析用于评估生存率。结果确定了27,210例患者:仅7235例(26.6%)接受了手术,而19,975例(73.4%)接受了额外的治疗。一半(53.1%)的患者具有完全的淋巴结切除术,而65.5%的患者可以进行完整的临床分期。所有这三项措施的总体遵守率为30.1%。在为期10年的研究期内,每种措施的依从性均提高了约20%。尽管经过调整后的分析显示,在学术课程中接受治疗的患者最有可能接受一致的护理,但是与综合社区课程中接受治疗的患者相比,综合护理网络中接受治疗的患者更有可能接受指南一致的护理(优势比[OR]为0.69)( OR,0.48)或社区计划(OR,0.45;所有P值<.001)。接受指南一致护理的患者中位总生存期为45.5个月,其中32位患者。不参加者为0个月(P <.001,所有OR的参考:学术课程)。结论符合指导原则与改善预后有关。尽管对NCCN指南的遵守率正在提高,但综合护理网络可能是提高社区内胃癌护理质量的重要途径。
更新日期:2019-12-11
中文翻译:
综合性癌症网络提高了对可切除胃癌国家指南和结果的依从性。
背景技术国家综合癌症网络(NCCN)指南建议对II至III期胃癌患者进行准确的临床分期,围手术期治疗和完整的淋巴结清扫术。但是,国家合规性仍然很低。据推测,整合的癌症网络可能会改善社区内的依从性和结果。方法检查接受根治性切除的II至III期胃腺癌患者(国家癌症数据库,2006-2015)。指南的依从性定义为任何围手术期辅助治疗,彻底的淋巴结清扫术,完全的临床分期和完全依从性(所有措施)。单变量比较和多变量回归用于评估与依从性相关的因素,而Kaplan-Meier分析用于评估生存率。结果确定了27,210例患者:仅7235例(26.6%)接受了手术,而19,975例(73.4%)接受了额外的治疗。一半(53.1%)的患者具有完全的淋巴结切除术,而65.5%的患者可以进行完整的临床分期。所有这三项措施的总体遵守率为30.1%。在为期10年的研究期内,每种措施的依从性均提高了约20%。尽管经过调整后的分析显示,在学术课程中接受治疗的患者最有可能接受一致的护理,但是与综合社区课程中接受治疗的患者相比,综合护理网络中接受治疗的患者更有可能接受指南一致的护理(优势比[OR]为0.69)( OR,0.48)或社区计划(OR,0.45;所有P值<.001)。接受指南一致护理的患者中位总生存期为45.5个月,其中32位患者。不参加者为0个月(P <.001,所有OR的参考:学术课程)。结论符合指导原则与改善预后有关。尽管对NCCN指南的遵守率正在提高,但综合护理网络可能是提高社区内胃癌护理质量的重要途径。