Abstract
Introduction Significant advancements have been made over the last 50 years in the areas of cancer biology, pathology, therapeutics, and surgical planning with only modest improvements in the overall survival of patients. Disparities in survival across different racial/ethnic groups and geography are multifactorial; however, a minimum set of quality indicators would allow us to assess adherence to clinical guideline therapy as a measure of quality care and a therapeutic standard all patients should be provided. The National Comprehensive Cancer Network (NCCN) has developed clinical practice guidelines to assist providers in the treatment and surveillance of patients across many primary cancer sites. In this systematic review, we aim to evaluate available literature assessing the relationship of NCCN guideline adherent cancer care and overall survival in gastrointestinal malignancies. Methods We performed a systematic literature search through June 2019. We searched MEDLINE (Pubmed) using a combination of MESH terms, only English language literature was included. Our search query was designed to assess the inclusion of survival data in studies evaluating the receipt of NCCN guideline adherent care in gastrointestinal cancers. Study exclusion criteria included: therapeutic or surgical clinical trial, non-NCCN guideline assessment, symptom-based guidelines, evaluation of tumor board or multidisciplinary team, disease specific practice guidelines. We plan to include additional disease groups: gynecologic, genitourinary, hepatobiliary, and breast cancer in our future analysis. Results The results of our review identified 59 studies, of which 23 studies were excluded based on criteria listed above. Of the 26 studies, 7 studies included overall survival as part of the statistical analysis in relation to compliance with NCCN guidelines. Of the 7 studies, 5 of these studies showed a favorable relationship with improved overall survival associated with increased compliance with NCCN guidelines. One study did not show a difference in overall survival, and one study had mixed results. This observed pattern supports the hypothesis that increased adherence to NCCN guidelines is associated with improved overall survival for patients with gastrointestinal malignancies. Conclusion Despite some limitations, our review has demonstrated that increased compliance with NCCN guidelines is associated with improved overall survival. Additional research is needed to further assess the relationship between NCCN guideline adherence and overall survival across other disease types. Specific parameters of the NCCN guideline should be analyzed to assess which aspects and sequences of treatment are most critical to patient survival. This effort could help assess opportunities for intervention for patients who are most at risk for receiving non-adherent guideline-based cancer care.
Citation Format: Kiran Clair, Sora Tanjasiri, Robert Bristow. Does adherence to National Comprehensive Cancer Network (NCCN) practice guidelines improve survival? [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D069.
