Guideline Adherence and Geriatric Assessment Studies among NCCN Scientific Posters of Interest 


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For the first time at the National Comprehensive Cancer Network (NCCN) Annual Conference, scientific posters were included as part of the program. The ASCO Post captured some of the most interesting findings for our readers, including the following news briefs. The findings of these studies support the use of NCCN Guidelines in patient care.

Medical Oncologists, Surgeons, and NCCN Guidelines

To learn more about physician’s attitudes toward and their use of NCCN Guidelines, investigators led by Reshma Jagsi, MD, DPhil, Associate Professor of Radiation Oncology at the University of Michigan Health System, Ann Arbor, surveyed 750 medical oncologists and 750 surgeons, analyzing responses from 766 respondents who reported seeing at least one new patient with breast cancer in the past year.1 They found attitudes to be generally favorable, with 96% reporting that they agreed with NCCN recommendations and a minority stating that NCCN Guidelines were outdated or overly restrictive.

Medical oncologists were more likely than surgeons to be aware of the NCCN Guidelines (100% vs 74%, P < .001) and to be influenced by them (96% vs 70%, P < .001). Although the vast majority (91%) of medical oncologists reported looking at the NCCN Guidelines more than once a year, fewer of the surgeons did so (59%, P < .001).

The NCCN Guidelines for breast cancer had been read completely by almost half the medical oncologists and about one-quarter of the surgeons (P < .001). Three-quarters of all respondents said their own practice conforms to the breast cancer guidelines. Still, 77% also reported that they refer, at most, one-quarter of their patients to the patient version.

“The NCCN Guidelines appear to have greater visibility to the medical oncology audience than to surgeons, and patient versions appear particularly infrequently recommended by providers,” Dr. Jagsi noted.

NCCN Guidelines and Diffuse Large B-cell Lymphoma

There is little evidence that adherence to clinical practice guidelines enhances survival in real-world practice settings, but researchers in St. Louis have contributed to this discussion with their study of 1,826 patients in the Veterans Health Administration cancer registry diagnosed with diffuse large B-cell lymphoma after June 1, 2000, the release date for the NCCN Guidelines.2

Kenneth Carson, MD, Assistant Professor of Medicine at St. Louis Veterans Affairs Medical Center and Washington University School of Medicine, and colleagues reported that the age-adjusted 3-year survival rate was 62% for patients who received treatment consistent with the NCCN Guidelines, vs 41% (P < .001) for the nonadherent group. By Cox analysis, increased mortality was associated with age, stage, B symptoms, comorbidities, and lactate dehydrogenase level. Use of granulocyte colony-stimulating factors was associated with a trend toward reduced mortality.

After controlling for these factors, the study found that patients whose initial treatments were recommended by the NCCN Guidelines had a 39% reduction in mortality. “Of note,” Dr. Carson added, “only 56% completed the appropriate number of treatment cycles and/or radiation to finish in guideline-adherent fashion.”

He said the findings suggest that adherence could be used as a quality measure that will correlate with survival. “Additional work is underway to fine-tune our results and understand the factors associated with beginning and completing treatment in adherent vs nonadherent fashion,” he said.

Geriatric Assessment and Ovarian Cancer

A cancer-specific geriatric assessment and weekly nursing telephone intervention is able to detect problems experienced by elderly women with ovarian cancer, according to a feasibility study from Memorial Sloan-Kettering Cancer Center, New York.3
William P. Tew, MD, a medical oncologist on Memorial’s Gynecologic Medical Oncology Service, and colleagues noted that more than half of patients with ovarian cancer are older than 65 years of age, and geriatric assessment, which can predict outcomes in other tumor types, is not commonly performed in this population.

In this study, 23 ovarian cancer patients (median age, 72 years) were enrolled in a study that evaluated a serial cancer-specific geriatric assessment (largely self-administered) and geriatric nursing telephone interventions in a gynecologic oncology practice. Subjects completed four assessments over 6 months, including before initiation of chemotherapy, during chemotherapy, at completion of chemotherapy, and after surgery.

They received a weekly telephone call from a geriatric nurse practitioner to reinforce medication compliance, to offer psychosocial support, and to facilitate appropriate referrals. Toxicity, quality of life, use of care, and satisfaction parameters were compared between the intervention group and patients receiving standard oncology care.

The preliminary results showed that patients can complete the brief geriatric assessment in a short period of time, 70% without assistance. The assessment identified problems not captured in routine visits, including fall history, which was reported by 14% of patients, significant cognitive impairment (9%), poor nutrition (33%), and severe depression or anxiety (45%). About two-thirds of patients appeared at medium-to-high risk for toxicity.

The patients reported that the assessment was easy to understand (78%) and of appropriate length (65%). Toxicity and outcomes will be reported at a later date. ■

Disclosure: Drs. Jagsi, Carson, and Tew received Young Investigator Award grants from the NCCN Foundation.

References

1. Jagsi R, Huang G, Griffith K, et al: Attitudes toward and use of cancer management guidelines in a national sample of medical oncologists and surgeons. 18th Annual Conference of the National Comprehensive Cancer Network. Abstract 2013-20. Presented March 15-16, 2013.

2. Carson K, Luo S, O’Brian K, et al: Adherence to National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology improves survival in veterans with diffuse large B-cell lymphoma. 18th Annual Conference of the National Comprehensive Cancer Network. Abstract 2013-17. Presented March 15-16, 2013.

3. Tew WP, Yulico HM, Hurria A, et al: Geriatric assessment and telephone intervention in elderly women with ovarian cancer: Preliminary findings. 18th Annual Conference of the National Comprehensive Cancer Network. Abstract 2013-19. Presented March 15-16, 2013.



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