The likelihood that a patient with cancer will receive guideline-concordant treatment varies according to cancer type, age, comorbidities, and center volume, according to a study published in Advances in Radiation Oncology.
Researchers aimed to evaluate factors associated with the use of guideline-concordant care for cancers with a National Comprehensive Cancer Network (NCCN) consensus for the use of multimodality treatment.
The researchers evaluated data from 178,005 patients with anal, rectal, cervical, nasopharyngeal, or non-small cell lung cancer from the National Cancer Database. These cancer types were selected because there was only 1 proposed treatment approach within the corresponding guideline, and treatment was multimodal.
Guideline-concordant care was administered to 91% of patients in the study, but the rate of concordance varied by cancer type.
The highest rate of non-concordant care was seen in patients with cervical cancer, at 21%. Non-concordant care was observed in 10% of patients with rectal cancer, 7% of those with non-small cell lung cancer, 5% of those with anal cancer, and 3% of those with nasopharyngeal cancer.
Factors associated with non-concordant care varied across the cancer types. However, in general, being older, having more comorbidities, and receiving treatment at a low-volume center were associated with a higher risk of receiving non-concordant care.
For cervical cancer, which had the highest proportion of patients receive non-concordant care, factors significantly associated with non-adherence included:
- Comorbidity score of 1 (odds ratio [OR], 1.22; 95% CI, 1.06-1.41)
- Private insurance (OR, 1.88; 95% CI, 1.55-2.30), compared with no insurance
- Medicare (OR, 1.62; 95% CI, 1.29-2.06), compared with no insurance
- Treatment at a comprehensive community cancer program (OR, 1.61; 95% CI, 1.43-1.80), compared with an academic research facility
- Treatment at an integrated network cancer program (OR, 1.30; 95% CI, 1.10-1.54), compared with an academic research facility.
Treatment at a high-volume center was associated with receiving concordant care (OR, 0.70; 95% CI, 0.57-0.86).
“The relatively large number of locally advanced cervical cancer patients receiving non-guideline concordant treatment may be explained by the fact that there is no seminal paper establishing chemotherapy and radiation as the standard treatment for these patients,” the researchers wrote.
“Nearly 1 in 10 patients in this cohort are not receiving appropriate multimodal cancer therapy. These patients’ survival may be impacted as a result, which should be investigated with future research.”
Tchelebi LT, Shen B, Wang M, et al. Non-adherence to multi-modality cancer treatment guidelines in the United States. Adv Rad Oncol. Published online March 8, 2022. doi:10.1016/j.adro.2022.100938