Predictors of Guideline Treatment Nonadherence and the Impact on Survival in Patients With Colorectal Cancer

Hines, Rebecca; Barrett, A.; Twumasi‐Ankrah, Philip; Broccoli, Dominique; Engelman, Kimberly K.; Baranda, Joaquina; Ablah, Elizabeth; Jacobson, Lisette T.; Redmond, Michelle L.; Tu, Wei; Collins, Tracie C.

doi:10.6004/jnccn.2015.0008

Cited by 41 publications

(47 citation statements)

References 33 publications

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“…The majority of patients received on-pathway and guideline recommended regimens during the first-line setting, although adherence dropped with subsequent lines. Other studies that have retrospectively evaluated adherence to guidelines or pathways for colorectal cancer have reported adherence rates to the initial primary therapy only, with reported adherence rates of 83% [5] [9]. Our study results of 88% and 84% adherence in the first line setting to NCCN guidelines and the US Oncology pathways respectively are consistent with that previously reported in the literature.…”

Section: Discussionsupporting

confidence: 87%

Treatment Patterns and Economic Assessment of Systemic Therapy for Metastatic Colorectal Cancer

Cartwright¹,

Wen²,

Harrell³

et al. 2016

JCT

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Introduction: Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the third leading cause of cancer deaths in the United States. The goal of this study was to understand treatment patterns, biomarker testing practices, treatment adherence, and the clinical and economic outcomes associated with chemotherapy for metastatic disease. Methods and Materials: We retrospectively examined electronic health records of patients with metastatic CRC who initiated chemotherapy between 01 January 2007 and 30 June 2011, with follow-up to 30 June 2012. Parameters analyzed included demographics and clinical characteristics, treatment patterns, clinical outcomes, and health care resource utilization. Results: In the analysis, 756 patients were included; median age was 61 years (55% male) at start of first line therapy. The most commonly used regimens in the first, second, and third line were FOLFOX + bevacizumab (46%), FOLFIRI + bevacizumab (23%), and irinotecan + cetuximab (23%) respectively. Adherence to guidelines decreased with increasing line of therapy. When assessed by treatment backbone categories in the third line, outcome measures including overall survival (OS), and time to treatment discontinuation (TTD) were not statistically different between groups. In the multivariable model, body mass index (BMI), performance status, and KRAS were significant predictors of survival. Conclusions: This study provides insight into patterns of care and outcomes of mCRC patients for the aforementioned time period. As treatment options for mCRC evolve, it is valuable to understand the continuum of care to help inform future treatment among candidates for continued therapy.

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Section: Discussionsupporting

confidence: 87%

Treatment Patterns and Economic Assessment of Systemic Therapy for Metastatic Colorectal Cancer

Cartwright¹,

Wen²,

Harrell³

et al. 2016

JCT

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“…10 Population and institutional studies have shown that adjuvant therapy may confer a survival advantage in some patients with resected colon cancer (eg, those with stage III or high-risk stage II disease). [11][12][13][14] Furthermore, randomized controlled trials have shown that the addition of oxaliplatin to these adjuvant regimens benefits some patients. [15][16][17][18][19] However, adjuvant treatment, especially with regimens containing oxaliplatin, is associated with considerable toxicity (notably chemotherapyinduced peripheral neuropathy), 16,20 and not all patients derive benefit.…”

Section: Risk Stratification and Adjuvant Treatment For Stage III Colmentioning

confidence: 99%

NCCN Guidelines Insights: Colon Cancer, Version 2.2018

Benson¹,

Venook²,

Al-Hawary³

et al. 2018

J Natl Compr Canc Netw

791

613

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The NCCN Guidelines for Colon Cancer provide recommendations regarding diagnosis, pathologic staging, surgical management, perioperative treatment, surveillance, management of recurrent and metastatic disease, and survivorship. These NCCN Guidelines Insights summarize the NCCN Colon Cancer Panel discussions for the 2018 update of the guidelines regarding risk stratification and adjuvant treatment for patients with stage III colon cancer, and treatment of V600E mutation-positive metastatic colorectal cancer with regimens containing vemurafenib.

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“…After examining the probability and frequency of emergency care utilization presented by other variables, we found that the deterioration of health conditions, such as advanced cancer staging and increase in outpatient visits and inpatient visits, increases the probability and frequency of emergency care utilization and there were significant differences among groups, which is consistent with the results of many studies on survival of patients with colorectal cancer. [11,32,33] Some studies suggested that patients with advanced colorectal cancer received the best quality of overall treatment with MDT, [34,35] which means that with the advance of colorectal cancer, the challenges to diagnosis, treatment and care would be greater. We hope to see more investigators dedicate their research in this area in the future.…”

Section: Discussionmentioning

confidence: 99%

Effects of multidisciplinary team on emergency care for colorectal cancer patients

et al. 2017

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The literature describing the effectiveness of multidisciplinary team (MDT) for the care of colorectal cancer remains unclear. We investigated the effects of MDT care on the quality of colorectal cancer treatment, and the emergency department visit number was used as an indicator. In total, 45,418 patients newly diagnosed with colorectal cancer from the Taiwan National Health Insurance Research Database (2005–2009) were included. Propensity score matching with a ratio of 1:3 was adopted to reduce differences in characteristics between MDT care participants and non-MDT care participants. After matching, 3039 participation MDT care groups and 9117 nonparticipation groups were included and analyzed with χ2 and t tests, determine the distribution was similar. Without the control of variables, the percentage difference between participation and nonparticipation MDT care groups in utilization of emergency care was 0.03% (P > .05). The logistic regression model involving controlled variables demonstrated that odds ratio (OR) by probability of emergency care used for participation MDT care groups within a year of cancer diagnosis was less than that for nonparticipation (OR = 0.87, 95% confidence interval: 0.78–0.96). Large amount data were used and confirmed significant benefits of MDT in colorectal cancer care.

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Predictors of Guideline Treatment Nonadherence and the Impact on Survival in Patients With Colorectal Cancer

Cited by 41 publications

References 33 publications

Treatment Patterns and Economic Assessment of Systemic Therapy for Metastatic Colorectal Cancer

Treatment Patterns and Economic Assessment of Systemic Therapy for Metastatic Colorectal Cancer

NCCN Guidelines Insights: Colon Cancer, Version 2.2018

Effects of multidisciplinary team on emergency care for colorectal cancer patients

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