Baseline institutional compliance with NCCN guidelines: non-small-cell lung cancer

To assess current physician practice patterns and whether they comply with guidelines published by the National Comprehensive Cancer Network (NCCN), we performed a retrospective review of 107 consecutive patients who underwent pulmonary resections for non-small-cell lung cancer at M. D. Anderson Cancer Center. Compliance with the guidelines was examined at four points in the patient's care: (1) preoperative work-up and evaluation, (2) operation performed and pathologic review, (3) postoperative adjuvant care, (4) routine follow-up and surveillance. Deviations from the guidelines were most marked in the preoperative evaluation phase. Excessive screening for metastases was performed in nearly 50% of the patients. Mediastinoscopy was appropriately utilized (according to the NCCN guidelines) in 93% of the patients, and appropriate anatomic resections and mediastinal nodal dissections were performed in 96% of the thoracotomies. Adjuvant care followed the NCCN recommendations in all patients. Excessive radiographic testing in asymptomatic patients was again seen in the postoperative surveillance program. Based on these findings, as well as the results of a previous evaluation of the cost-effectiveness of follow-up care in patients with resected lung cancers, we conclude that more widespread adherence to the radiographic recommendations in the NCCN guidelines would result in significant institutional and national health-care savings.