Surgical Oncologists Typically Follow Treatment Guidelines

A vast majority of Medicare patients with cancer are receiving appropriate surgical care that is in line with current treatment guidelines. While this is good news for most surgical oncology patients, a recent study revealed that doctors did not follow expert guidelines as closely for some gastric and colon procedures where the evidence for the “correct” treatment was less convincing.

The research team, led by Caprice C. Greenberg, MD, MPH, Director of the Center for Surgery and Public Health at Brigham and Women’s Hospital in Boston, Massachusetts, looked at variations in surgical care in 5 types of cancer. The results were published online this week in the Archives of Surgery.

The retrospective cohort study analyzed records from more than 100,000 fee-for-service Medicare patients aged 65 years or older who had undergone surgical resection for breast, colon, gastric, rectal, or thyroid cancer diagnosed between 2000 and 2005. The researchers compared the cancer care these patients received with established practice guidelines in surgical oncology.

The authors found that hospitals treating patients with adjuvant therapy adhered to established practice guidelines more than 90% of the time. Hospitals showed the highest concordance with the guidelines for breast cancer surgery, likely, the authors speculate, because those guidelines have been around for a long time and are based on solid evidence.

However, the study showed that less than 50% of hospitals followed guidelines for lymph node removal in patients with gastric or colon cancer. The guidelines call for a minimum number of lymph nodes to be removed for examination in each case, but the evidence supporting these guidelines is more controversial.

“When there’s really good evidence, it looks like people are pretty consistently getting that kind of care, Greenberg said in a press release. “However, if guidelines are based on a consensus of what people think might be the right thing to do, guidelines are consistently followed.”

Despite the low concordance rates in lymph node removal in patients with colon or gastric cancer, recent studies have shown that doctors are getting better at following colon cancer guidelines. Yet Greenberg acknowledged that surgeons need to generate more data to further define appropriate care for patients with cancer and translate these evidenced-based findings into everyday practice.

Greenberg CC, Lipsitz SR, Neville B, et al. Receipt of appropriate surgical care for Medicare beneficiaries with cancer [published online ahead of print June 20, 2011]. Arch Surg. doi:10.1001/archsurg.2011.141.