Analysis of Clinical and Economic Implications of Esmo 2014 Clinical Practice Guidelines for Metastatic Colorectal Cancer Treatment

53 Background: Despite surgery, the 5-year risk of systemic recurrence of colorectal cancer (CRC) in the absence of any further therapy is approximately 50 % for those with lymph node involvement and 20 ─ 30 % if the lymph nodes are negative. Adjuvant chemotherapy contributes to improved disease-free and overall survival for node-positive (stage III) or high-risk node negative (stage IIB) colon cancer. Similar benefits are observed for adjuvant chemoradiotherapy in rectal cancer. Previous research shows varied rates of adherence to published adjuvant chemotherapy Clinical Practice Guidelines (CPGs) for CRC, although population-based data is scarce. Purpose: The aim of this analysis was to assess adherence rates to adjuvant chemotherapy prescription within 16 weeks of surgery according to local and international CPGs for CRC patients treated with curative intent between 2008 and 2019 at the Uruguayan National Cancer Institute. Data regarding factors associated with chemotherapy receipt beyond 16 weeks from surgery and chemotherapy non receipt was also retrieved and analysed. Methods: We retrospectively reviewed medical and pathology reports of 833 patients diagnosed with CRC at our institution. Patients with stages IIB or III CRC who underwent curative-intent surgery were identified and included in the present analysis. A 16-week benchmark timeline for treatment initiation from date of surgery was considered. Fisher’s exact test was used to determine factors independently associated with receipt of chemotherapy and meeting the 16-week benchmark (p 0.05). Results: A total of 400 patients were identified of which 72% had peritoneal colorectal tumors and 28% had sub-peritoneal rectal tumors. Approximately 70% of the latter group received neoadjuvant chemo-radiotherapy. Considering the total cohort, 61% received adjuvant chemotherapy. Factors predicting chemotherapy receipt in the peritoneal colorectal group were age ≤ 70 and stage III disease. In the sub-peritoneal rectal group no significant effect was found. The 16-week benchmark was met in 72% (175) of those receiving chemotherapy and 70.6% (167) completed 6 months of systemic adjuvant treatment. A total of 156 patients (39%) did not receive adjuvant chemotherapy. The factors predicting chemotherapy non receipt were age > 70 and stage IIB in the peritoneal colorectal group. Conclusions: This analysis of adherence to CPGs identified several factors associated with chemotherapy non receipt and chemotherapy receipt outside of timeline benchmarks from date of curative-intent surgery in Montevideo, Uruguay. The two main factors significantly associated with chemotherapy non receipt were advanced age and lower disease stage. To our knowledge, our data is the first to elucidate these specific factors in the Uruguayan CRC patient population.

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Comprehensive value assessment of drugs using a multi-criteria decision analysis: An example of targeted therapies for metastatic colorectal cancer treatment

PLoS ONE ◽

10.1371/journal.pone.0225938 ◽

2019 ◽

Vol 14 (12) ◽

pp. e0225938 ◽

Cited By ~ 1

Author(s):

Jason C. Hsu ◽

Jia-Yu Lin ◽

Peng-Chan Lin ◽

Yang-Cheng Lee

Keyword(s):

Colorectal Cancer ◽

Decision Analysis ◽

Cancer Treatment ◽

Metastatic Colorectal Cancer ◽

Targeted Therapies ◽

Value Assessment ◽

Multi Criteria Decision Analysis ◽

Colorectal Cancer Treatment

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1997 update of recommendations for the use of tumor markers in breast and colorectal cancer. Adopted on November 7, 1997 by the American Society of Clinical Oncology.

Journal of Clinical Oncology ◽

10.1200/jco.1998.16.2.793 ◽

1998 ◽

Vol 16 (2) ◽

pp. 793-795 ◽

Cited By ~ 86

Keyword(s):

Breast Cancer ◽

Colorectal Cancer ◽

Clinical Practice ◽

Clinical Oncology ◽

Tumor Markers ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Disease Free Survival ◽

Research Committee ◽

American Society

OBJECTIVE The primary objective was to update the 1996 clinical practice guidelines for the use of tumor marker tests in the prevention, screening, treatment, and surveillance of breast and colorectal cancers. These guidelines are intended for use in the care of patients outside of clinical trials. OPTIONS Six tumor markers for colorectal cancer and eight for breast cancer were considered. They could be recommended or not for routine use or for special circumstances. In addition to carcinoembryonic antigen (CEA) and cancer antigen (CA) 15-3, CA 27.29 also was considered in regard to circulatory tumor markers for breast cancer. OUTCOMES In general, the significant health outcomes identified for use in making clinical practice guidelines (overall survival, disease-free survival, quality of life, lesser toxicity, and cost effectiveness) were used. EVIDENCE A computerized literature search from 1994 to July 1997 was performed. VALUES The same values for Use, Utility, and Levels of Evidence were used by the Committee. BENEFITS, HARMS, AND COSTS The same benefit, harms, and costs were used. RECOMMENDATION No changes in any guidelines were recommended (see text). VALIDATION External review by the American Society of Clinical Oncology (ASCO) Health Services Research Committee and by ASCO Board of Directors. SPONSOR American Society of Clinical Oncology.

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Exploring international differences in ovarian cancer treatment: a comparison of clinical practice guidelines and patterns of care

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001403 ◽

2020 ◽

Vol 30 (11) ◽

pp. 1748-1756

Author(s):

Charles H Norell ◽

John Butler ◽

Rhonda Farrell ◽

Alon Altman ◽

James Bentley ◽

...

Keyword(s):

Ovarian Cancer ◽

Clinical Practice ◽

Health System ◽

Cancer Treatment ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Patterns Of Care ◽

Debulking Surgery ◽

Potential Health ◽

International Differences

IntroductionThe International Cancer Benchmarking Partnership demonstrated international differences in ovarian cancer survival, particularly for women aged 65–74 with advanced disease. These findings suggest differences in treatment could be contributing to survival disparities.ObjectiveTo compare clinical practice guidelines and patterns of care across seven high-income countries.MethodsA comparison of guidelines was performed and validated by a clinical working group. To explore clinical practice, a patterns of care survey was developed. A questionnaire regarding management and potential health system-related barriers to providing treatment was emailed to gynecological specialists. Guideline and survey results were crudely compared with 3-year survival by ‘distant’ stage using Spearman’s rho.ResultsTwenty-seven guidelines were compared, and 119 clinicians completed the survey. Guideline-related measures varied between countries but did not correlate with survival internationally. Guidelines were consistent for surgical recommendations of either primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery with the aim of complete cytoreduction. Reported patterns of surgical care varied internationally, including for rates of primary versus interval debulking, extensive/‘ultra-radical’ surgery, and perceived barriers to optimal cytoreduction. Comparison showed that willingness to undertake extensive surgery correlated with survival across countries (rs=0.94, p=0.017). For systemic/radiation therapies, guideline differences were more pronounced, particularly for bevacizumab and PARP (poly (ADP-ribose) polymerase) inhibitors. Reported health system-related barriers also varied internationally and included a lack of adequate hospital staffing and treatment monitoring via local and national audits.DiscussionFindings suggest international variations in ovarian cancer treatment. Characteristics relating to countries with higher stage-specific survival included higher reported rates of primary surgery; willingness to undertake extensive/ultra-radical procedures; greater access to high-cost drugs; and auditing.

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