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Guideline-Concordance High for Surgical Cancer Patients

But concordance with guidelines is low in some areas, including nodal management

TUESDAY, June 21 (HealthDay News) -- The guideline-concordance levels are mainly high in surgical oncology care, but are lower in certain areas, including nodal management, according to a study published online June 20 in the Archives of Surgery.

Caprice C. Greenberg, M.D., M.P.H., from Brigham and Women's Hospital in Boston, and colleagues investigated the receipt of recommended surgical care in Medicare beneficiaries with cancer. Fee-for-service Medicare patients aged 65 years or older diagnosed with breast, colon, gastric, rectal, or thyroid cancer between January 2000 and December 2005 who underwent definitive surgical resection were included. The relevant claims data from January 1999 to December 2007 were reviewed. The rate of care concordance with established guidelines was determined for 11 guidelines at the patient and hospital levels.

The investigators found that concordance was more than 90 percent for seven out of 11 measures, including all guidelines for adjuvant therapy. The concordance rates for nodal management were greater than 90 percent in two of five measures. Guideline-concordant care was provided to 100 percent of patients for six of 11 guidelines in at least 50 percent of the hospitals. The recipients of appropriate care was seen in patients who tended to be younger, healthier, white, more affluent, with less advanced disease, and who lived in the Midwest.

"We found a high level of concordance with guidelines in some domains of surgical oncology care but far less so in others, particularly for gastric and colon nodal management," the authors write.

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