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

Tyler P Robinson; Kristen Kaiser; Meghan Lark; Brian Ruedinger; Bruce W Robb; Teryn Morgan; Seho Park; Titus K L Schleyer; David A Haggstrom; Sanjay Mohanty

doi:10.1016/j.amjsurg.2024.116114

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

Am J Surg. 2024 Nov 28:240:116114. doi: 10.1016/j.amjsurg.2024.116114. Online ahead of print.

Authors

Affiliations

¹ Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA.
² Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
³ Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
⁴ Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
⁵ Regenstrief Institute, Inc., Indianapolis, IN, USA.
⁶ Department of Industrial and Data Engineering Hongik University, Seoul, Republic of Korea.
⁷ Regenstrief Institute, Inc., Indianapolis, IN, USA; Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
⁸ Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA. Electronic address: smohanty1@iuhealth.org.

PMID: 39671967
DOI: 10.1016/j.amjsurg.2024.116114

Abstract

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 guideline-concordance 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 non-concordance 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.

Keywords: Adherence; Cancer; Colon; Concordance; Guideline; Oncology; Rectum.