Adverse Outcomes Associated with Noncompliance with Melanoma Treatment Guidelines

Foster, Jennifer E.; Velasco, Josè M.; Hieken, Tina J.

doi:10.1245/s10434-008-0021-0

Cited by 52 publications

(25 citation statements)

References 23 publications

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“…This study also noted variation in compliance based on geographic area and improved compliance over time during the 4‐year study period. Similar findings with respect to excision margins were published in 2008 from a single teaching institution experience demonstrating that 87% of patients with in‐situ and thin melanomas, yet only 60% of patients with T2‐T4 primaries, received guideline‐appropriate margins of excision 89. Findings obtained from querying the National Cancer Database (NCDB) of the American College of Surgeons demonstrated that of 8,525 patients with clinical stage IB/II disease, 48.7% underwent SLN biopsy 90.…”

Section: Compliance With Guidelines: How We Are Doing and Concluding supporting

confidence: 80%

“…This study revealed that in terms of compliance with excision margins, non‐compliant treatment was associated with a 17% complication rate—3.4‐fold higher than the overall complication rate. Furthermore, local and regional relapse as the first site of failure was higher in the stage I and II patients who received initial non‐compliant management: 24% versus 6% for patients categorized as non‐compliant vs compliant, respectively 89.…”

Section: Compliance With Guidelines: How We Are Doing and Concluding mentioning

confidence: 94%

“…The impact of non‐compliance was also assessed using the above mentioned single institution registry data 89. This study revealed that in terms of compliance with excision margins, non‐compliant treatment was associated with a 17% complication rate—3.4‐fold higher than the overall complication rate.…”

Section: Compliance With Guidelines: How We Are Doing and Concluding mentioning

confidence: 98%

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Evidence‐based treatment of early‐stage melanoma

Ross

Gershenwald

2011

Journal of Surgical Oncology

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The vast majority of patients with newly diagnosed melanoma are "early-stage" - ie, clinically localized to the primary cutaneous site. For such patients, surgery represents the mainstay of treatment; current standards of surgical management have evolved based on evidence obtained from randomized trials, large multi-center and single institutional databases, and consensus panels. Treatment strategies include wide excision of the primary site with margins dictated by important biological features such as Breslow tumor thickness, and sentinel node biopsy to surgically evaluate the regional nodal basins at risk. Sentinel node biopsy has become an important component of the initial management of many of these patients for accurate staging of regional lymph nodes, as well as enhanced regional disease control and improved survival in the patients with microscopically involved nodes. Evidence is presented that supports the rational use of these surgical strategies and reconciles some of the controversies that have emerged. The degree to which established national treatment guidelines are followed and the consequences of non-compliance with these guidelines have become the focus of recent clinical investigations; results of these efforts are also discussed.

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Section: Compliance With Guidelines: How We Are Doing and Concluding supporting

confidence: 80%

Section: Compliance With Guidelines: How We Are Doing and Concluding mentioning

confidence: 94%

Section: Compliance With Guidelines: How We Are Doing and Concluding mentioning

confidence: 98%

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Evidence‐based treatment of early‐stage melanoma

Ross

Gershenwald

2011

Journal of Surgical Oncology

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“…Both underutilization of evidence-based care and overutilization of unnecessary services have been documented 3–18. The former can lead to worse cancer outcomes, whereas the latter increases the cost of care without increasing value 16. To address these concerns across all specialties, the American Board of Internal Medicine (ABIM) Foundation launched an initiative to improve “appropriateness” of medical care in the United States.…”

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confidence: 99%

Measures of Appropriateness and Value for Breast Surgeons and Their Patients: The American Society of Breast Surgeons Choosing Wisely ® Initiative

et al. 2016

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BackgroundCurrent breast cancer care is based on high-level evidence from randomized, controlled trials. Despite these data, there continues to be variability of breast cancer care, including overutilization of some tests and operations. To reduce overutilization, the American Board of Internal Medicine Choosing Wisely® Campaign recommends that professional organizations provide patients and providers with a list of care practices that may not be necessary. Shared decision making regarding these services is encouraged.MethodsThe Patient Safety and Quality Committee of the American Society of Breast Surgeons (ASBrS) solicited candidate measures for the Choosing Wisely® Campaign. The resulting list of “appropriateness” measures of care was ranked by a modified Delphi appropriateness methodology. The highest-ranked measures were submitted to and later approved by the ASBrS Board of Directors. They are listed below.Results(1) Don’t routinely order breast magnetic resonance imaging in new breast cancer patients. (2) Don’t routinely excise all the lymph nodes beneath the arm in patients having lumpectomy for breast cancer. (3) Don’t routinely order specialized tumor gene testing in all new breast cancer patients. (4) Don’t routinely reoperate on patients with invasive cancer if the cancer is close to the edge of the excised lumpectomy tissue. (5) Don’t routinely perform a double mastectomy in patients who have a single breast with cancer.ConclusionsThe ASBrS list for the Choosing Wisely® campaign is easily accessible to breast cancer patients online. These measures provide surgeons and their patients with a starting point for shared decision making regarding potentially unnecessary testing and operations.

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“…Several reports measuring adherence to National Comprehensive Cancer Network (NCCN) guidelines have demonstrated a relationship between compliance and improved outcomes in a variety of malignancies, including melanoma, 31 colon cancer, 32,33 pancreatic cancer, 34 gastric cancer, 35 and others. [36][37][38] In an effort to improve adherence to CPGs, multidisciplinary cancer clinics (MDCs) were introduced, which showed higher concordance with published CPGs compared to non-multidisciplinary clinics.…”

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confidence: 99%

An audit of referral and treatment patterns of high-risk prostate cancer patients in Alberta

Alghamdi

Taggar

Tilley

et al. 2016

CUAJ

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Introduction: We aimed to determine the impact of clinical practice guidelines (CPG) on rates of radiation oncologist (RO) referral, androgen-deprivation therapy (ADT), radiation therapy (RT), and radical prostatectomy (RP) in patients with high-risk prostate cancer (HR-PCa). Methods: All men >18 years, diagnosed with PCa in 2005 and 2012 were identified from the Alberta Cancer Registry. Patient age, aggregated clinical risk group (ACRG) score, Gleason score (GS), pre-treatment prostate-specific antigen (PSA), RO referral, and treatment received were extracted from electronic medical records. Logistic regression modelling was used to examine associations between RO referral rates and relevant factors. Results: HR-PCa was diagnosed in 261 of 1792 patients in 2005 and 435 of 2148 in 2012. Median age and ACRG scores were similar in both years (p>0.05). The rate of patients with PSA >20 were 67% and 57% in 2005 and 2012, respectively (p=0.004). GS ≤6 was found in 13% vs. 5% of patients, GS 7 in 27% vs. 24%, and GS ≥8 in 59% vs. 71% in 2005 and 2012, respectively (p<0.001). In 2005, RO referral rate was 68% compared to 56% in 2012 (p=0.001), use of RT + ADT was 53% compared to 32% (p<0.001), and RP rate was 9% vs. 17% (p=0.002). On regression analysis, older age, 2012 year of diagnosis and higher PSA were associated with decreased RO referral rates (odds ratios [OR] 0.49, 95% confidence interval [CI] 0.39-0.61; OR 0.51, 95% CI 0.34-0.76; and OR 0.64, 95% CI 0.39-0.61), respectively [p<0.001]). Conclusions: Since CPG creation in 2005, RO referral rates and ADT + RT use declined and RP rates increased, which demonstrates a need to improve adherence to CPG in the HR-PCa population.

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Adverse Outcomes Associated with Noncompliance with Melanoma Treatment Guidelines

Abstract: While there are valid reasons for variance from treatment algorithms, these data suggest that compliance with NCCN guidelines improves outcome and decreases morbidity in clinically node-negative melanoma patients.

Cited by 52 publications

References 23 publications

Evidence‐based treatment of early‐stage melanoma

Evidence‐based treatment of early‐stage melanoma

Measures of Appropriateness and Value for Breast Surgeons and Their Patients: The American Society of Breast Surgeons Choosing Wisely ® Initiative

An audit of referral and treatment patterns of high-risk prostate cancer patients in Alberta

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