title: Failure to comply with NCCN guidelines for the management of pancreatic cancer compromises outcomes.
abstract: BACKGROUND
  There are little data available regarding compliance with the National Comprehensive Cancer Network (NCCN) guidelines. We investigated variation in the management of pancreatic cancer (PC) among large hospitals in California, USA, specifically to evaluate whether compliance with NCCN guidelines correlates with patient outcomes.
  
  
  METHODS
  The California Cancer Registry was used to identify patients treated for PC from 2001 to 2006. Only hospitals with ≥ 400 beds were included to limit evaluation to centres possessing resources to provide multimodality care (n= 50). Risk-adjusted multivariable models evaluated predictors of adherence to stage-specific NCCN guidelines for PC and mortality.
  
  
  RESULTS
  In all, 3706 patients were treated for PC in large hospitals during the study period. Compliance with NCCN guidelines was only 34.5%. Patients were less likely to get recommended therapy with advanced age and low socioeconomic status (SES). Using multilevel analysis, controlling for patient factors (including demographics and comorbidities), hospital factors (e.g. size, academic affiliation and case volume), compliance with NCCN guidelines was associated with a reduced risk of mortality [odds ratio (OR) for death 0.64 (0.53-0.77, P < 0.0001)].
  
  
  CONCLUSIONS
  There is relatively poor overall compliance with the NCCN PC guidelines in California's large hospitals. Higher compliance rates are correlated with improved survival. Compliance is an important potential measure of the quality of care.
authors: Department of Surgery, Stanford University Medical Center, CA 94305-5641, USA. bvisser@stanford.edu
authors: Brendan C
authors: BC
authors: Visser
authors: Yifei
authors: Y
authors: Ma
authors: Yulia
authors: Y
authors: Zak
authors: George A
authors: GA
authors: Poultsides
authors: Jeffrey A
authors: JA
authors: Norton
authors: Kim F
authors: KF
authors: Rhoads
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D054625:Healthcare Disparities / Q000592:standards; D006742:Hospital Bed Capacity / Q000592:standards; D006761:Hospitals / Q000592:standards*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008495:Medical Oncology / Q000592:standards*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome