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NCCN Guideline Adherence Improves Survival Outcomes in Anal Cancer

February 04, 2021


Priyanka Kumar, MD, University of California, Irvine Medical Center, discusses a recent study which analyzed adherence to the National Comprehensive Cancer Network (NCCN) treatment guidelines for anal squamous cell carcinoma in California and the associated impacts on survival.

The results of this study were presented at the virtual 2021 ASCO Gastrointestinal Cancers Symposium.


Hi, I'm Priyanka. I am currently an internal medicine resident at the University of California, Irvine Medical Center. I'm here to talk with you guys today about our abstract from the ASCO GI 2021 meeting.

Our abstract was a population‑based analysis of the National Comprehensive Cancer Network guideline adherence for patients with anal squamous cell carcinoma in California. Basically, our study, just some background on our study.

That it was analyzing adherence to the National Comprehensive Cancer Network treatment guidelines for anal squamous cell cancer patients and looking at the different associated impacts on survival that these factors might have.

For our methods, it was a retrospective cohort study where we looked at adult patients, like 18 to about age 80, that were diagnosed with anal squamous cell cancer from a defined time period, either between January 2004 and 2017 with about maybe 1‑year follow‑up.

These patients were all taken from the California Cancer Registry. We were looking at different demographic information, as well as tumor information and tumor stage. With these patients, we determined whether the patients received NCCN guideline‑adherent care by these predefined criteria.

Afterwards, we looked at both logistic regression models for receiving the adherent care just to look at whether there was a relationship between different demographic factors and adherent care. We also looked at survival, so overall survival and disease‑specific survival, using different Cox regression models.

Some of the more interesting results of our study were that we had 4740 patients that had a diagnosis of anal squamous cell carcinoma in California. Of these patients, about 19.5% or 926 patients did not receive adherent care.

One of the main findings was that non‑adherent care had worse overall survival, as well as worse disease‑specific survival. That was a really important finding. Certain factors were also more associated with adherent care than others.

A notable finding was that Medicaid patients, for instance, were less likely to receive adherent care, with an odds ratio of 0.75%. Patients in the lowest socioeconomic status section were also less likely to receive adherent care.

Characteristics in particular that were associated with survival, some of these included female gender, Black race, Medicare/Medicaid status, and socioeconomic status as well. Overall, we concluded from our study that NCCN guideline‑adherent care was associated with improved disease‑specific as well as overall survival in these squamous cell carcinoma patients.

The implication of our study was that guideline‑adherent care is important, but it's especially important in targeting more vulnerable groups. Clinicians should direct their efforts in making sure that vulnerable populations are receiving adherent care going forward, redoubling efforts to make sure that these disparities are addressed.

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