HSR20-105: The Impact of Gastric Cancer Clinical Pathways Based on National Comprehensive Cancer Network Guidelines on Treatment Heterogeneity and Clinical Outcomes in the US Oncology Network

280 Background: The members of a network of community cancer centers affiliated with an academic medical center report following National Comprehensive Cancer Network (NCCN) guidelines. To determine guideline compliance, cisplatin regimens were audited. Cisplatin was selected because of its wide use, high emetic potential, and the impact on QOL for patients with unmanaged nausea and vomiting.The community cancer centers affiliated with an academic medical center report following National Comprehensive Cancer Network (NCCN) guidelines for treatment plans. To determine guideline compliance rates, cisplatin regimens were audited. Cisplatin was selected because of its wide use, high emetic potential, and the impact on QOL for patients with unmanaged nausea and vomiting. Methods: Prior to a chart audit, medical oncologists were surveyed on their knowledge of NCCN antiemesis guidelines, frequency of prescribing based on guidelines, and reasons for not using guidelines. Auditors identified patient charts through billing records and reviewed cycle 1 day 1 orders of cisplatin regimens. Secondary data was collected on hydration orders and home medications for antiemesis. Results: Guideline adherence varied from 0% to 76% with overall adherence at 28%. Dexamethasone doses ranged from 2-20 mg (guideline 12 mg) as did serotonin antagonists (5HT3) ordered at higher IV doses of 24-32 mg (guideline 8-16 mg). Conclusions: Although cancer centers report following the guidelines, this study did not find consistent adherence. The cancer center with the highest adherence rate works closely with a pharmacist and has built order sets with the guidelines. One cancer center had wide variances among practitioners. The variances increase the potential for error. The cancer center with lowest adherence rate used 10 mg doses of dexamethasone because the drug is delivered in 10 mg vials. This study identified multiple systems issues impacting guideline compliance. Managing nausea and vomiting is important for patient QOL and to manage costs by decreasing hospitalizations, treatment delays, and nutritional deficits. Understanding prescribing habits relative to guidelines provides an opportunity to change practice and reduce variability.

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New cancer-related fatigue and anaemia guidelines for patients with cancer have been released by the US National Comprehensive Cancer Network (NCCN) and the American Cancer Society.

Inpharma Weekly ◽

10.2165/00128413-200313880-00008 ◽

2003 ◽

Vol &NA; (1388) ◽

pp. 4

Author(s):

&NA;

Keyword(s):

National Comprehensive Cancer Network ◽

American Cancer Society ◽

Cancer Society ◽

Patients With Cancer ◽

Cancer Related Fatigue ◽

The Us ◽

Cancer Network

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Impact of GI Tumor Board on Patient Management and Adherence to Guidelines

Journal of Global Oncology ◽

10.1200/jgo.17.00164 ◽

2018 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Haneen A. AlFarhan ◽

Ghada F. Algwaiz ◽

Hajer A. Alzahrani ◽

Roaa S. Alsuhaibani ◽

Ashwaq Alolayan ◽

...

Keyword(s):

National Comprehensive Cancer Network ◽

Patient Management ◽

Stage Iv ◽

Tumor Board ◽

Multidisciplinary Teams ◽

Adherence To Guidelines ◽

New Findings ◽

Common Diagnosis ◽

Cancer Network ◽

The Impact

Purpose As the burden of cancer on the population and the health care system continues to increase with more complicated treatment options, the need for multidisciplinary teams to be as efficient as possible becomes more vital. Our study aimed to evaluate the consistency of GI Tumor Board (GI TB) recommendations with international guidelines, the adherence of physicians involved in patient care to TB recommendations, and the impact on the management of patients. Methods A prospective cohort study was conducted from January to June 2016 at our institution, which is a major tertiary hospital that provides comprehensive cancer care. All cases presented at the GI TB during this period were included. Data regarding adherence to National Comprehensive Cancer Network guidelines, adherence to TB recommendations, and changes made to the management of patients were collected weekly from the GI TB in a data collection form. Results Of the 104 patients included, 57 (55%) were males and the median age was 58 (16 to 85) years. Colorectal cancer was the most common diagnosis, in 65 patients (63%). Nearly one-half of cases (45%) were stage IV cancers. Starting new treatment was recommended for 72 patients (69%). Further investigations were requested for 15 patients (14%). For imaging, 24 recommendations (23%) were made. Adherence to National Comprehensive Cancer Network guidelines was observed in 97% of total recommendations. New findings were found in pathology (11%), radiology (13%), and staging (4%). Management plans were changed in 37 cases (36%). Over a 3-month period after presentation to the GI TB, most of the recommendations (87%) were performed. Conclusion A multidisciplinary tumor board enhances the adherence to guidelines and has an impact on patient management in approximately one-third of patients. Among physicians, adherence to recommendations of the TB was high.

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Financial conflicts of interest among the National Comprehensive Cancer Network (NCCN) Clinical Practice Guideline (CPG) Panelists in 2019.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.15 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 15-15

Author(s):

Aakash Desai ◽

Madhuri Chengappa ◽

Ronald S. Go ◽

Thejaswi Poonacha

Keyword(s):

Expert Witness ◽

Conflicts Of Interest ◽

Standard Of Care ◽

Nccn Guidelines ◽

Non Hodgkin Lymphoma ◽

Advisory Boards ◽

The Us ◽

Financial Conflicts Of Interest ◽

Cancer Network ◽

The Impact

15 Background: CPG are evidence-based guidelines, which serve as a standard of care in practice, quality improvement, and reimbursement. The extent of financial conflicts of Interest (FCOI) in NCCN guidelines has not been recently evaluated. Our study evaluated the extent of FCOI in the NCCN CPG among the 10 most common malignancies in the US. Methods: We examined the latest 2019 version of the NCCN CPG for the 10 most common cancers by incidence in the US. Using disclosure lists, we catalogued the FCOIs for the panelists under various categories outlined in the CPG. We also tabulated the companies/institutions involved in each disclosure. An “episode” describes 1 instance of participation of a panelist in 1 company in 1 category of each guideline. “Affiliation” describes a commercial, industry, or institute affiliation reported by a panelist in each episode. Results: Of the 491 panelists on the CPG, 483 (98.3%) completed FCOI disclosures. 224 (46.38%) reported at least 1 FCOI. A total of 1,103 episodes were disclosed with an average of 4.9 episodes per panelist with FCOI. Being a part of scientific advisory boards, consultant, or expert witness was the most common FCOI category (19.9%). A total of 191 companies were associated with 1,103 episodes of FCOI. The top companies were Bristol Myers Squibb, Merck, Genentech and AstraZeneca. Among the top 10 cancers, the prevalence of FCOI were lung (56%), bladder (52%), pancreatic (52%), non-Hodgkin lymphoma (50%), kidney (49%), colorectal (43%), breast (42%), melanoma (40%), prostate (38%), and uterine (32%). Among the panelists with FCOI, 26%, 17%, and 57% reported 1, 2, and > 3 episodes, respectively. There were 127 episodes among the CPG chairs/vice chairs who reported FCOI (mean 6.4). The chairs/vice chairs of uterine, pancreatic, melanoma, and prostate cancer CPG did not have any FCOI. Conclusions: FCOI are very prevalent among the top 10 NCCN CPG panelists. In almost half of the CPG, the majority of the panelists had at least 1 FCOI. Over half of the CPG chairs/vice chairs reported multiple FCOI. Further studies are necessary to determine the impact of these FCOI.

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Association Between Rapid Response Algorithms and Clinical Outcomes of Hospitalized Children

Hospital Pediatrics ◽

10.1542/hpeds.2020-005603 ◽

2021 ◽

Vol 11 (12) ◽

pp. 1385-1394

Author(s):

Jonathan G. Sawicki ◽

Dana Tower ◽

Elizabeth Vukin ◽

Jennifer K. Workman ◽

Gregory J. Stoddard ◽

...

Keyword(s):

Clinical Outcomes ◽

Clinical Pathways ◽

Rapid Response ◽

Future Research ◽

Hospitalized Children ◽

Rapid Response System ◽

Response System ◽

Algorithm Implementation ◽

The Impact ◽

Over Time

OBJECTIVES To evaluate whether the implementation of clinical pathways, known as pediatric rapid response algorithms, within an existing rapid response system was associated with an improvement in clinical outcomes of hospitalized children. METHODS We retrospectively identified patients admitted to the PICU as unplanned transfers from the general medical and surgical floors at a single, freestanding children’s hospital between July 1, 2017, and January 31, 2020. We examined the impact of the algorithms on the rate of critical deterioration events. We used multivariable Poisson regression and an interrupted time series analysis to measure 2 possible types of change: an immediate implementation effect and an outcome trajectory over time. RESULTS We identified 892 patients (median age: 4 [interquartile range: 1–12] years): 615 in the preimplementation group, and 277 in the postimplementation group. Algorithm implementation was not associated with an immediate change in the rate of critical deterioration events but was associated with a downward rate trajectory over time and a postimplementation trajectory that was significantly less than the preimplementation trajectory (trajectory difference of −0.28 events per 1000 non-ICU patient days per month; 95% confidence interval −0.40 to −0.16; P < .001). CONCLUSIONS Algorithm implementation was associated with a decrease in the rate of critical deterioration events. Because of the study’s observational nature, this association may have been driven by unmeasured confounding factors and the chosen implementation point. Nevertheless, the results are a promising start for future research into how clinical pathways within a rapid response system can improve care of hospitalized patients.

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