Compliance with gastric cancer guidelines is associated with improved outcomes.
BACKGROUND
Limited data are available on the implementation and effectiveness of NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Gastric Cancer.


OBJECTIVE
We sought to assess rates of compliance with NCCN Guidelines, specifically stage-specific therapy during the initial episode of care, and to determine its impact on outcomes.


METHODS
The California Cancer Registry was used to identify cases of gastric cancer from 2001 to 2006. Logistic regression and Cox proportional hazard models were used to predict guideline compliance and the adjusted hazard ratio for mortality. Patients with TNM staging or summary stage (SS) were also analyzed separately.


RESULTS
Compliance with NCCN Guidelines occurred in just 45.5% of patients overall. Patients older than 55 years were less likely to receive guideline-compliant care, and compliance was associated with a median survival of 20 versus 7 months for noncompliant care (P<.001). Compliant care was also associated with a 55% decreased hazard of mortality (P<.001). Further analysis revealed that 50% of patients had complete TNM staging versus an SS, and TNM-staged patients were more likely to receive compliant care (odds ratio, 1.59; P<.001). TNM-staged patients receiving compliant care had a median survival of 25.3 months compared with 15.1 months for compliant SS patients.


CONCLUSIONS
Compliance with NCCN Guidelines and stage-specific therapy at presentation for the treatment of patients with gastric cancer was poor, which was a significant finding given that compliant care was associated with a 55% reduction in the hazard of death. Additionally, patients with TNM-staged cancer were more likely to receive compliant care, perhaps a result of having received more intensive therapy. Combined with the improved survival among compliant TNM-staged patients, these differences have meaningful implications for health services research.
From the Department of Surgery, Stanford University Medical Center, and Stanford Cancer Institute, Stanford, California.
David J
DJ
Worhunsky
From the Department of Surgery, Stanford University Medical Center, and Stanford Cancer Institute, Stanford, California. From the Department of Surgery, Stanford University Medical Center, and Stanford Cancer Institute, Stanford, California.
Yifei
Y
Ma
From the Department of Surgery, Stanford University Medical Center, and Stanford Cancer Institute, Stanford, California.
Yulia
Y
Zak
From the Department of Surgery, Stanford University Medical Center, and Stanford Cancer Institute, Stanford, California.
George A
GA
Poultsides
From the Department of Surgery, Stanford University Medical Center, and Stanford Cancer Institute, Stanford, California.
Jeffrey A
JA
Norton
From the Department of Surgery, Stanford University Medical Center, and Stanford Cancer Institute, Stanford, California. From the Department of Surgery, Stanford University Medical Center, and Stanford Cancer Institute, Stanford, California.
Kim F
KF
Rhoads
From the Department of Surgery, Stanford University Medical Center, and Stanford Cancer Institute, Stanford, California.
Brendan C
BC
Visser
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D019983:Guideline Adherence; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D012042:Registries; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000473:pathology