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Adherence to neoadjuvant therapy guidelines for locally advanced rectal cancers in a region with sociodemographic
Denise L Wong1, Leah E Hendrick1, Whitney M Guerrero1
1Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave, Suite 300, Memphis, TN, 38163, USA.
Background:
Practice guidelines recommend neoadjuvant chemoradiation (NCR) for locally advanced rectal cancer (LARC). We examined guideline adherence in a healthcare system serving a region with socioeconomic disparities and poor cancer outcomes.
Methods:
Retrospective analysis of factors associated with guideline adherence.
Results:
63.1% of stage II/III LARC patients received NCR. Factors associated with adherence included white race (OR = 2.15, p = 0.024), private insurance (OR = 2.70, p = 0.005), employed status (OR = 2.30, p = 0.031), age at diagnosis (OR = 0.74, p = 0.032), appropriate local staging (OR = 9.17, p < 0.0001), and diagnosis later in the study period (OR per 1 year = 1.20, p = 0.006). By multivariate analysis, private insurance (OR = 2.51, p = 0.023), younger age (OR per 10 years = 0.72, p = 0.048) and appropriate local staging (OR = 6.67, p < 0.0001) were associated with adherence.
Conclusion:
Guideline adherence for LARC in our system is low and is impacted by employment, race and insurance status. Standard of care compliance remains an important target for improvement efforts in this underserved region of the nation's Mid-South.
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