T. P. Robinson1, K. Kaiser1, M. Lark1, D. A. Haggstrom2, S. Mohanty1 1Indiana University School Of Medicine, Department Of Surgery, Indianapolis, IN, USA 2Indiana University School Of Medicine, Department Of Medicine, Indianapolis, IN, USA
Introduction: National clinical guidelines, such as those produced by the National Comprehensive Cancer Care Network (NCCN), provide recommendations for evaluation, treatment, and surveillance of patients with colorectal cancer. Adherence to evidence-based guidelines reduces care variation and improves outcomes. Determining rates of adherence to cancer care guidelines is an important step in understanding current gaps in care and developing targeted system-wide implementation interventions. The goals of this study were to 1) define guideline-concordant care for colorectal cancer; 2) describe rates of guideline-concordance in a large vertically integrated health system; and 3) determine factors associated with receiving guideline-concordant care.
Methods: A retrospective cohort of colorectal cancer patients were identified from a single-state 16 hospital health-system cancer registry diagnosed between 2011-2021. Patients were excluded if they had missing demographic or staging information or if the patient refused treatment. We defined guideline-concordance for colon and rectal cancer based on NCCN guidelines. Continuous variables were analyzed using a t-test or Mann Whitney U test, and categorical variables were analyzed using a χ2 test or Fischer exact test where appropriate. Regression methods were used to determine factors associated with the receipt of guideline-concordant care.
Results: Overall, there was a guideline-concordance rate of 73.8% (n=3,403), with guideline-concordance rates of 73.2% (n=2,390) for colon cancer and 75.0%(n=1,013) for rectal cancer. On univariate analysis, younger patients, private insurance, stage I cancer, and longer time from diagnosis to surgery had significantly increased rates of guideline concordance (all p-values <0.001). On multivariate analysis, age (OR 0.98 CI 0.96-0.99), private insurance (OR 1.74 CI 1.27-2.38), cancer stage (Stage II OR 0.05 CI 0.04-0.08, Stage III OR 0.20 CI 0.14-0.30, Stage IV OR 0.09 CI 0.06-0.15), and time from diagnosis to surgery (OR 1.00 CI 1.00-1.01) were significant predictors of guideline-concordance.
Conclusion: We have identified factors that are associated with receiving guideline concordant care. The association of age and private insurance with guideline concordance among colon and rectal cancer patients may be due to morbidity and access, respectively. Stage II-IV cancers require more nuanced care, allowing for more opportunities for non-concordance. Finally, increased time from diagnosis to surgery may afford more time for providers to complete all aspects of guideline concordance. This information will be used to guide a future intervention designed to improve guideline-concordance by making data more available and actionable for clinicians.
