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Harold J. Burstein

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Gregory P. Kalemkerian

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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

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Rodger J. Winn

receiving adjuvant chemotherapy . Breast Cancer Res Treat 2006 ; 100 : 255 – 262 . 3. Bach PB . Costs of cancer care: a view from the centers for Medicare and Medicaid services . J Clin Oncol 2007 ; 25 : 187 – 190 .

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Rodger J. Winn

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Noman Ahmed Jang Khan, Mahmoud Abdallah, Todd Gress, and Mohamed Alsharedi

Background: The 21 gene assay Oncotype Dx Breast Recurrence Score (RS) is currently the standard of care to determine if adjuvant chemotherapy is needed in early stage hormone receptor positive, node negative, HER-2 negative breast cancer. In

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Rosalyn A. Juergens and Julie R. Brahmer

Vanecko RM Fry WA . Site of recurrence in patients with stages I and II carcinoma of the lung resected for cure . Ann Thorac Surg 1981 ; 32 : 23 – 27 . 6. Arriagada R Bergman B Dunant A . Cisplatin-based adjuvant chemotherapy in patients

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NCCN Guidelines Insights: Breast Cancer, Version 3.2018

Featured Updates to the NCCN Guidelines

Matthew P. Goetz, William J. Gradishar, Benjamin O. Anderson, Jame Abraham, Rebecca Aft, Kimberly H. Allison, Sarah L. Blair, Harold J. Burstein, Chau Dang, Anthony D. Elias, William B. Farrar, Sharon H. Giordano, Lori J. Goldstein, Steven J. Isakoff, Janice Lyons, P. Kelly Marcom, Ingrid A. Mayer, Meena S. Moran, Joanne Mortimer, Ruth M. O'Regan, Sameer A. Patel, Lori J. Pierce, Elizabeth C. Reed, Hope S. Rugo, Amy Sitapati, Karen Lisa Smith, Mary Lou Smith, Hatem Soliman, Melinda L. Telli, John H. Ward, Jessica S. Young, Dorothy A. Shead, and Rashmi Kumar

reduce the risk of recurrence, and those deemed at high risk for distant recurrence despite adjuvant endocrine therapy receive adjuvant chemotherapy. The incremental benefit of adding adjuvant chemotherapy to endocrine therapy in patients with a low

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S. Machele Donat

patient data advanced bladder cancer (ABC) meta-analysis collaboration . Eur Urol 2005 ; 48 : 202 – 206 . 18 Advanced Bladder Cancer Meta-analysis Collaboration . Adjuvant chemotherapy in invasive bladder cancer: a systematic review and meta

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Brian Vicuna and Al B. Benson III

products discussed in the article or their competitors. References 1. Jemal A Siegel R Ward E . Cancer statistics, 2007 . CA Cancer J Clin 2007 57 : 43 – 66 . 2. Schrag D Rifas-Shiman S Saltz L . Adjuvant chemotherapy use