Analyzing the Impact of Compliance with National Guidelines for Pancreatic Cancer Care Using the National Cancer Database

Importance: Management of pancreatic cancer is complex, requiring coordination of multiple providers. National Comprehensive Cancer Network guidelines, developed for standardization and quality improvement, recommend a multimodal approach. Objective: This study analyzed national rates of compliance with National Comprehensive Cancer Network recommendations, assessed factors affecting compliance, and evaluated whether compliance with evidence-based guidelines improved overall survival. Design: This is a retrospective review of adults diagnosed with pancreatic cancer entered into the National Cancer Database. Patients included had stage I and II pancreatic cancer, and complete data in the database. Patients were classified as compliant if they underwent both surgery and a second treatment modality (chemotherapy, radiation, or chemoradiation). Clinico-pathologic variables were analyzed using univariate and multivariate models to predict overall survival. Setting: Hospital-based national study population. Participants: Patients with stage I or II pancreatic cancer. Main Outcomes and Measures: Compliance with National Comprehensive Cancer Network recommendations, factors affecting compliance, and overall survival based on compliance. Results: A total of 52,450 patients were included; 19,272 patients (37%) were compliant. Patients were found to be most compliant in the 50–59-year-old range (49% complaint), with decreased compliance at the extremes of age. Male patients were more compliant than female patients (39 vs 34%, p < 0.0001). Caucasians were more compliant (39%) than African Americans (32%) or other races (32%, p < 0.0001). Patients treated at academic/research centers were more compliant than patients treated at other facilities (39% compliant, p < 0.0001). Patients with stage II disease were more compliant compared with stage I disease (43 vs 18%, p < 0.0001). Compliance was shown to improve overall survival (p < 0.0001). Conclusion: Adherence to National Comprehensive Cancer Network guidelines for pancreatic cancer patients improves survival. Compliance nationwide is low, especially for older patients and minorities and those treated outside academic centers. More studies will need to be performed to identify factors that hinder compliance.