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Robinson TP, Kaiser K, Lark M, Ruedinger B, Robb BW, Morgan T, Park S, Schleyer TKL, Haggstrom DA, Mohanty S. NCCN guideline concordance in colon and rectal cancer patients within a comprehensive health system. American journal of surgery. 2024 Nov 28; 240:116114.
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.