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Efrat Dotan, Ilene Browner, Arti Hurria, and Crystal Denlinger

received adjuvant chemotherapy. 27 Similar percentages were seen in a SEER Medicare population-based analysis of patients with stage III colon cancer. 28 In this analysis, the documented survival of patients aged 75 to 84 years with early-stage disease

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Zachary Veitch, Omar F. Khan, Derek Tilley, Patricia A. Tang, Domen Ribnikar, Douglas A. Stewart, Xanthoula Kostaras, Karen King, and Sasha Lupichuk

Background Treatment of early-stage breast cancer with adjuvant chemotherapy has improved survival. Landmark meta-analyses by the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) initially showed a 20% to 25% relative risk reduction in

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Julie R. Gralow, J. Sybil Biermann, Azeez Farooki, Monica N. Fornier, Robert F. Gagel, Rashmi Kumar, Georgia Litsas, Rana McKay, Donald A. Podoloff, Sandy Srinivas, and Catherine H. Van Poznak

receiving standard adjuvant chemotherapy experience at least temporary amenorrhea, and as many as 50% to 70% may experience permanent ovarian failure or early menopause. 30 , 31 No standard definition for chemotherapy-induced ovarian failure exists in the

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Amy A. Kirkham, Kelcey A. Bland, Holly Wollmann, Alis Bonsignore, Don C. McKenzie, Cheri Van Patten, Karen A. Gelmon, and Kristin Campbell

adjuvant chemotherapy for breast cancer, randomized controlled trials (RCTs) have demonstrated that supervised aerobic or resistance exercise training has superior effects to both usual care and home-based exercise on health-related physical fitness and QoL

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Hinda Boutrid, Maryam Lustberg, Jeffrey Vandeusen, Sagar Sardesai, Daniel Stover, Robert Wesolowski, Mathew Cherian, Julie Stephens, Marilly Palettas, Evan Morgan, Mohmoud Kassem, Michael Berger, Craig A. Vargo, Bhuvaneswari Ramaswamy, and Nicole Williams

disease from invasive ductal cancer. It has been previously shown that invasive lobular cancer may not be as sensitive to adjuvant chemotherapy. We showed that in the metastatic setting there was no difference in PFS and OS among first line treatment

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Himani Aggarwal, Kristin M. Sheffield, Li Li, David Lenis, Rachael Sorg, and Rebecca Miksad

of adjuvant chemotherapy vs BEV RPTL patients (47.6% vs 22.3%; P <.001). In the matched sample, median overall survival (OS) was 29.7 months (95% CI, 26.9–35.2) for LPTL patients vs 18.3 months (95% CI, 15.8–21.3) for RPTL patients ( P <.001). Median

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Margaret A. Tempero

Outcomes for pancreatic cancer are becoming less discouraging with the refinement of molecular profiling, both germline and somatic, and beneficial effects seen with adjuvant chemotherapy. The NCCN Guidelines for Pancreatic Adenocarcinoma reflect these advances, and recommend that clinicians consider germline testing for all patients with pancreatic cancer and consider a molecular analysis for those with metastatic disease. The guidelines further recommend that clinicians consider adjuvant therapy with modified FOLFIRINOX (leucovorin/5-FU/irinotecan/oxaliplatin) for patients who are able to tolerate it.

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Gregory P. Kalemkerian

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Harold J. Burstein

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Dorothy Romanus, Martin R. Weiser, John M. Skibber, Anna Ter Veer, Joyce C. Niland, John L. Wilson, Ashwani Rajput, Yu-Ning Wong, Al B. Benson III, Stephen Shibata, and Deborah Schrag


The National Comprehensive Cancer Network (NCCN) Outcomes Database was created to assess concordance to evidence- and consensus-based guidelines and to measure adherence to quality measures on an ongoing basis. The Colorectal Cancer Database began in 2005 as a collaboration among 8 NCCN centers.


Newly diagnosed colon and rectal cancer patients presenting to 1 of 8 NCCN centers between September 1, 2005, and May 21, 2008, were eligible for analysis of concordance with NCCN treatment guidelines for colorectal cancer and with a set of quality metrics jointly developed by ASCO and NCCN in 2007. Adherence rates were determined for each metric. Center-specific rates were benchmarked against mean concordance rates for all participating centers.


A total of 3443 patients were evaluable. Mean concordance rates with NCCN colorectal cancer guidelines and ASCO/NCCN quality measures were generally high (≥ 90%). However, relatively low mean concordance rates were noted for adjuvant chemotherapy treatment recommendations within 9 months of diagnosis of stage II to III rectal cancer (81%), and neoadjuvant chemoradiation in clinical T4 rectal primaries (83%). These low rates of concordance seemed to be consistent across centers.


Adherence to guidelines and quality measures is generally high at institutions participating in the NCCN colorectal cancer database. Lack of documentation, patient refusal, delayed treatment initiation, and lack of consensus about whether treatment was essential were the primary reasons for nonconcordance. Measurement of concordance and the reasons for nonconcordance enable participating centers to understand and improve their care delivery systems.