Are there variations in adherence to colorectal cancer clinical guidelines depending on treatment place and recommendation novelty? The French EvaCCoR observational study - 19/11/18

Doi : 10.1016/j.clinre.2018.10.008

S. Lamy ^a,^b,^c,^⁎ , R. Guimbaud ^d,^e, L. Digue ^f,^g, I. Cirilo-Cassaigne ^f, V. Bousser ^f, E. Oum-Sack ^e, J. Goddard ^e, E. Bauvin ^e, C. Delpierre ^c, P. Grosclaude ^c,^h
the EvaCCoR Group
^a University of Toulouse III Paul-Sabatier, 31000 Toulouse, France
^b Department of clinical pharmacology, Toulouse university hospital, 31000 Toulouse, France
^c Inserm UMR1027 (The French national institute of health and medical research), 31000 Toulouse, France
^d Digestive medical oncology unit, Toulouse university hospital, Toulouse university cancer institute (IUCT-O), 31100 Toulouse, France
^e Occitanie regional cancer network (Onco-Occitanie), 31100 Toulouse, France
^f Aquitaine regional cancer network, 33076 Bordeaux, France
^g Department of clinical oncology, Bordeaux university hospital, 33000 Bordeaux, France
^h Tarn cancers registry, 81000 Albi, France

^⁎Corresponding author at: UMR université de Toulouse Paul-Sabatier, Inserm 1027, Equipe labelisée LIGUE contre le cancer, faculté de médecine, UMR 1027 Inserm, 37, allées Jules Guesde, 31062 Toulouse, France.UMR université de Toulouse Paul-SabatierInserm 1027Equipe labelisée LIGUE contre le cancerfaculté de médecineUMR 1027 Inserm37, allées Jules GuesdeToulouse31062France

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Highlights

•	Our results supported higher overall proportions of guidelines-based practices for the former clinical recommendations than for the most recent.
•	The largest between-centers differences in guidelines adherence were not find for the most recent recommendations.
•	The mechanisms of guidelines-based practices diffusion are unclear and seem to depend on the type of recommendation.

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Summary

Background

Studies have shown clinical practices variation between centers in colorectal cancer (CRC) management. After the implementation of national cancer plans, we tested for differences in center and patients’ socioeconomic position (SEP)-related variation in CRC guidelines.

Methods

All patients aged 18 years and over, cared for a first CRC in 2010 in Southwest of France. We used mixed effect model to test for center-related heterogeneity (CRH) in recommendation, from the oldest to the more recent: (1) at least 12 lymph nodes analysed for stage II, (2) the prescription of adjuvant chemotherapy stage III and (3) the assessment of CRC molecular phenotype regarding KRAS status for stage IV. Patients’ SEP was approached by an ecological social deprivation index.

Results

We found: higher adherence for the oldest than for the most recent recommendations; no CRH in recommendation No. 2 but lower adherence in academic centers; a CRH for recommendations No. 1 and 3; no SEP-related differences in clinical practices.

Conclusion

Results showed that older recommendations have higher adherence but did not support increasing influence of centers characteristics and CRH as recommendations are more recent.

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Keywords : Adherence to guidelines, Between-center variation, Observational study, Colorectal cancer management, Social inequality in health