Abstract
BackgroundClinical guidelines are generated to preserve high-quality evidence-based care. Data on the implementation of guidelines into clinical practice are scarce, despite that guideline adherence prevents over- and undertreatment and correlates with survival. Therefore, we investigated guideline adherence for the systemic treatment in high-risk stage II and stage III colon cancer and metastatic colorectal cancer. Patients and MethodsIn all Dutch hospitals (n = 88) 1 medical oncologist involved in colorectal cancer care was approached to participate. An online survey was conducted regarding the local standard of care for adjuvant chemotherapy in high-risk stage II and stage III colon cancer and first-line treatment regimens in metastatic colorectal cancer. Frequency tables were provided for categorical variables and compared for differences in guideline adherence according to hospital type (academic/teaching/regional). ResultsThe overall response rate was 70% (62 of 88). Reported guideline adherence was at least 60% of all presented settings. For high-risk stage II and stage III colon cancer, treatment strategies agreed with national guidelines in 66% and 84% of hospitals, and overtreatment patterns were identified in 28% and 13%, respectively. Targeted therapy was not routinely administered as first-line treatment in metastatic colorectal cancer (range from 63% to 71% in different settings). No differences in guideline adherence were observed among different hospital types. ConclusionGuideline adherence as reported by medical oncologists in The Netherlands is suboptimal. Possible explanations include unawareness or disagreement with the guidelines, or local financial restrictions. Our results recommend additional support of guideline implementation and monitoring in clinical practice, and investigating underlying causes in case of nonadherence.
Highlights
Clinical practice guidelines are generated to improve high-quality evidence-based care of patients and to prevent undesirable practice variation
In patients with early stage (I and II) colon cancer, the use of adjuvant chemotherapy has been restricted, which implies that fewer patients should be exposed to the morbidity that is associated with this treatment.[2]
Responding medical oncologists had a median experience of 13 years in oncology since their registration
Summary
Clinical practice guidelines are generated to improve high-quality evidence-based care of patients and to prevent undesirable practice variation. The national guideline serves as a basis for clinical practice, but it is known that hospitals in The Netherlands might differ in their interpretation of the guidelines. In 2014, a new Dutch guideline for colorectal cancer was published, which included updated recommendations for adjuvant chemotherapy for high-risk stage II and stage III colon cancer and systemic treatment for metastatic colorectal disease.[1] In patients with early stage (I and II) colon cancer, the use of adjuvant chemotherapy has been restricted, which implies that fewer patients should be exposed to the morbidity (and sometimes mortality) that is associated with this treatment.[2] In the metastatic setting, treatment options have been expanded by the incorporation of novel targeted drugs in treatment regimens, leading to improved survival.[2] There are no significant differences between Dutch guideline recommendations and international European Society for Medical Oncology (ESMO)[3,4] and National Comprehensive Cancer Network (NCCN) guidelines.[5] American Society of Clinical Oncology colorectal cancer guidelines for systemic therapy are lacking, except for an outdated (2004) guideline regarding adjuvant chemotherapy for stage II colon cancer.[6]
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