TY - JOUR
T1 - Nationwide compliance with a multidisciplinary guideline on pancreatic cancer during 6-year follow-up
AU - Mackay, Tara M.
AU - Latenstein, Anouk E. J.
AU - Bonsing, Bert A.
AU - Bruno, Marco J.
AU - van Eijck, Casper H. J.
AU - Koerkamp, Bas Groot
AU - de Hingh, Ignace H. J. T.
AU - Homs, Marjolein Y.
AU - van Hooft, Jeanin E.
AU - van Laarhoven, Hanneke W.
AU - Molenaar, I. Quintus
AU - van Santvoort, Hjalmar C.
AU - Stommel, Martijn W. J.
AU - de Vos-Geelen, Judith
AU - Wilmink, Johanna W.
AU - Busch, Olivier R.
AU - van der Geest, Lydia G.
AU - Besselink, Marc G.
N1 - Funding Information:
Source of funding; The Dutch Pancreatic Cancer Project, including the Netherlands Cancer Registry, received funding from the Dutch Cancer Society (KWF Kankerbestrijding; grant no. UVA2013-5842 ). The authors thank the registration team of the Netherlands Cancer Registry for their dedicated data collection.
Publisher Copyright:
© 2020 IAP and EPC
PY - 2020/12
Y1 - 2020/12
N2 - Background: Compliance with national guidelines on pancreatic cancer management could improve patient outcomes. Early compliance with the Dutch guideline was poor. The aim was to assess compliance with this guideline during six years after publication.Materials and methods: Nationwide guideline compliance was investigated for three subsequent time periods (2012-2013 vs. 2014-2015 vs. 2016-2017) in patients with pancreatic cancer using five quality indicators in the Netherlands Cancer Registry: 1) discussion in multidisciplinary team meeting (MDT), 2) maximum 3-week interval from final MDT to start of treatment, 3) preoperative biliary drainage when bilirubin >250 mu mol/L, 4) use of adjuvant chemotherapy, and 5) chemotherapy for inoperable disease (non-metastatic and metastatic).Results: In total, 14 491 patients were included of whom 2290 (15.8%) underwent resection and 4561 (31.5%) received chemotherapy. Most quality indicators did not change over time: overall, 88.8% of patients treated with curative intent were discussed in a MDT, 42.7% were treated with curative intent within the 3-week interval, 62.7% with a resectable head tumor and bilirubin >250 mu mol/L underwent preoperative biliary drainage, 57.2% received chemotherapy after resection, and 36.6% with metastatic disease received chemotherapy. Only use of chemotherapy for non-metastatic, non-resected disease improved over time (23.4% vs. 25.6% vs. 29.7%).Conclusion: Nationwide compliance to five quality indicators for the guideline on pancreatic cancer management showed little to no improvement during six years after publication. Besides critical review of the current quality indicators, these outcomes may suggest that a nationwide implementation program is required to increase compliance to guideline recommendations. (C) 2020 IAP and EPC. Published by Elsevier B.V. All rights reserved.
AB - Background: Compliance with national guidelines on pancreatic cancer management could improve patient outcomes. Early compliance with the Dutch guideline was poor. The aim was to assess compliance with this guideline during six years after publication.Materials and methods: Nationwide guideline compliance was investigated for three subsequent time periods (2012-2013 vs. 2014-2015 vs. 2016-2017) in patients with pancreatic cancer using five quality indicators in the Netherlands Cancer Registry: 1) discussion in multidisciplinary team meeting (MDT), 2) maximum 3-week interval from final MDT to start of treatment, 3) preoperative biliary drainage when bilirubin >250 mu mol/L, 4) use of adjuvant chemotherapy, and 5) chemotherapy for inoperable disease (non-metastatic and metastatic).Results: In total, 14 491 patients were included of whom 2290 (15.8%) underwent resection and 4561 (31.5%) received chemotherapy. Most quality indicators did not change over time: overall, 88.8% of patients treated with curative intent were discussed in a MDT, 42.7% were treated with curative intent within the 3-week interval, 62.7% with a resectable head tumor and bilirubin >250 mu mol/L underwent preoperative biliary drainage, 57.2% received chemotherapy after resection, and 36.6% with metastatic disease received chemotherapy. Only use of chemotherapy for non-metastatic, non-resected disease improved over time (23.4% vs. 25.6% vs. 29.7%).Conclusion: Nationwide compliance to five quality indicators for the guideline on pancreatic cancer management showed little to no improvement during six years after publication. Besides critical review of the current quality indicators, these outcomes may suggest that a nationwide implementation program is required to increase compliance to guideline recommendations. (C) 2020 IAP and EPC. Published by Elsevier B.V. All rights reserved.
KW - Pancreatic cancer
KW - Guideline
KW - Compliance
KW - Management
KW - PREOPERATIVE BILIARY DRAINAGE
KW - ADJUVANT CHEMOTHERAPY
KW - ENHANCED RECOVERY
KW - SURGERY
KW - PANCREATICODUODENECTOMY
KW - GEMCITABINE
KW - FOLFIRINOX
KW - FAILURE
KW - CARE
U2 - 10.1016/j.pan.2020.10.032
DO - 10.1016/j.pan.2020.10.032
M3 - Article
C2 - 33069583
SN - 1424-3903
VL - 20
SP - 1723
EP - 1731
JO - Pancreatology
JF - Pancreatology
IS - 8
ER -