Does Quality of Care Matter? A Study of Adherence to National Comprehensive Cancer Network Guidelines for Patients with Locally Advanced Esophageal Cancer

Daniela Molena, Benedetto Mungo, Miloslawa Stem, Amy K. Poupore, Sophia Y. Chen, Anne O. Lidor

Research output: Contribution to journalArticle

Abstract

Introduction: The aim of this study was to assess whether adherence to National Comprehensive Cancer Network (NCCN) guidelines leads to differences in survival in patients diagnosed with locally advanced esophageal cancer. Methods: This is a retrospective cohort study of patients with stage II and III esophageal cancer included in the Cancer Registry at the Sidney Kimmel Comprehensive Cancer Center at the Johns Hopkins Hospital from 2008 to 2013. Seven quality indicators were identified using the 2014 NCCN guidelines, and individual and overall quality measure scores were calculated and used to define low and high quality of care groups. Results: One hundred forty-one patients met inclusion criteria, and 88 patients (62.4 %) were identified as receiving high-quality care. Adherence to guidelines ranged from 63.1 to 100.0 %, with an overall compliance of 81.3 %. Risk factors for receiving low quality of care included advanced age, non-white race, lower education level, and unspecified primary site of tumor. A significantly better overall survival was observed in patients who received high-quality care (HR, 0.58; 95 %, 0.37–0.90, p = 0.015). Conclusions: Delivery of high-quality care is associated with improved survival in these patients. Efforts should be directed at minimizing disparities in treatment in regards to race and educational levels.

Original languageEnglish (US)
Pages (from-to)1739-1747
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume19
Issue number10
DOIs
StatePublished - Oct 29 2015

Keywords

  • Esophageal cancer
  • NCCN guidelines
  • Quality of care
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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