Are there variations in adherence to colorectal cancer clinical guidelines depending on treatment place and recommendation novelty? The French EvaCCoR observational study.
Academic Medical Centers
/ statistics & numerical data
Adenocarcinoma
/ pathology
Aged
Chemotherapy, Adjuvant
/ statistics & numerical data
Colorectal Neoplasms
/ pathology
Female
France
/ epidemiology
Guideline Adherence
/ statistics & numerical data
Hospitals, Private
/ statistics & numerical data
Hospitals, Public
/ statistics & numerical data
Humans
Longitudinal Studies
Lymph Nodes
/ pathology
Male
Practice Guidelines as Topic
Retrospective Studies
Adherence to guidelines
Between-center variation
Colorectal cancer management
Observational study
Social inequality in health
Journal
Clinics and research in hepatology and gastroenterology
ISSN: 2210-741X
Titre abrégé: Clin Res Hepatol Gastroenterol
Pays: France
ID NLM: 101553659
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
26
03
2018
revised:
29
08
2018
accepted:
15
10
2018
pubmed:
19
11
2018
medline:
21
4
2020
entrez:
19
11
2018
Statut:
ppublish
Résumé
Studies have shown clinical practices variation between centers in colorectal cancer (CRC) management. After the implementation of national cancer plans, we tested for differences in center and patients' socioeconomic position (SEP)-related variation in CRC guidelines. All patients aged 18 years and over, cared for a first CRC in 2010 in Southwest of France. We used mixed effect model to test for center-related heterogeneity (CRH) in recommendation, from the oldest to the more recent: (1) at least 12 lymph nodes analysed for stage II, (2) the prescription of adjuvant chemotherapy stage III and (3) the assessment of CRC molecular phenotype regarding KRAS status for stage IV. Patients' SEP was approached by an ecological social deprivation index. We found: higher adherence for the oldest than for the most recent recommendations; no CRH in recommendation No. 2 but lower adherence in academic centers; a CRH for recommendations No. 1 and 3; no SEP-related differences in clinical practices. Results showed that older recommendations have higher adherence but did not support increasing influence of centers characteristics and CRH as recommendations are more recent.
Sections du résumé
BACKGROUND
Studies have shown clinical practices variation between centers in colorectal cancer (CRC) management. After the implementation of national cancer plans, we tested for differences in center and patients' socioeconomic position (SEP)-related variation in CRC guidelines.
METHODS
All patients aged 18 years and over, cared for a first CRC in 2010 in Southwest of France. We used mixed effect model to test for center-related heterogeneity (CRH) in recommendation, from the oldest to the more recent: (1) at least 12 lymph nodes analysed for stage II, (2) the prescription of adjuvant chemotherapy stage III and (3) the assessment of CRC molecular phenotype regarding KRAS status for stage IV. Patients' SEP was approached by an ecological social deprivation index.
RESULTS
We found: higher adherence for the oldest than for the most recent recommendations; no CRH in recommendation No. 2 but lower adherence in academic centers; a CRH for recommendations No. 1 and 3; no SEP-related differences in clinical practices.
CONCLUSION
Results showed that older recommendations have higher adherence but did not support increasing influence of centers characteristics and CRH as recommendations are more recent.
Identifiants
pubmed: 30447905
pii: S2210-7401(18)30224-9
doi: 10.1016/j.clinre.2018.10.008
pii:
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
346-356Informations de copyright
Copyright © 2018 Elsevier Masson SAS. All rights reserved.