Same thyroid cancer, different national practice guidelines: When discordant American Thyroid Association and National Comprehensive Cancer Network surgery recommendations are associated with compromised patient outcome
Background The American Thyroid Association (ATA) and National Comprehensive Cancer Network (NCCN) guidelines have discordant recommendations for managing patients with differentiated thyroid cancer (DTC). We hypothesized that physician adherence to either of the 2009 extent of surgery guidelines of...
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| Veröffentlicht in: | Surgery 2016-01, Vol.159 (1), p.41-51 |
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| creator | Adam, Mohamed Abdelgadir, MD Goffredo, Paolo, MD Youngwirth, Linda, MD Scheri, Randall P., MD Roman, Sanziana A., MD Sosa, Julie A., MD, MA |
| description | Background The American Thyroid Association (ATA) and National Comprehensive Cancer Network (NCCN) guidelines have discordant recommendations for managing patients with differentiated thyroid cancer (DTC). We hypothesized that physician adherence to either of the 2009 extent of surgery guidelines of the ATA or NCCN was associated with improved survival, and that practice is most standardized nationally when guidelines are concordant. Methods Adult patients undergoing surgery for DTC were included from the National Cancer Database. Multivariable modeling was used to identify factors associated with nonadherence to the 2009 ATA or NCCN guidelines (2010–2011) and hypothetically examine the association of retrospective adherence to guidelines with survival (1998–2006). Results A total of 39,687 patients with DTC were included; 2,249 were not treated in accordance with ATA or NCCN guidelines. Factors independently associated with nonadherence were discordance between ATA and NCCN recommendations, black race, and treatment at nonacademic centers ( P |
| doi_str_mv | 10.1016/j.surg.2015.04.056 |
| format | Article |
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We hypothesized that physician adherence to either of the 2009 extent of surgery guidelines of the ATA or NCCN was associated with improved survival, and that practice is most standardized nationally when guidelines are concordant. Methods Adult patients undergoing surgery for DTC were included from the National Cancer Database. Multivariable modeling was used to identify factors associated with nonadherence to the 2009 ATA or NCCN guidelines (2010–2011) and hypothetically examine the association of retrospective adherence to guidelines with survival (1998–2006). Results A total of 39,687 patients with DTC were included; 2,249 were not treated in accordance with ATA or NCCN guidelines. Factors independently associated with nonadherence were discordance between ATA and NCCN recommendations, black race, and treatment at nonacademic centers ( P < .01). After adjustment, care not in accordance with either set of guidelines was associated with compromised survival (hazard ratio 1.16, P = .02). Conclusion A minority of patients received surgery for DTC not aligned with guidelines; nonadherent care was associated with compromised survival. Discordance in recommendations between guidelines is associated with reduction in adherent care, suggesting that standardizing guidelines could decrease confusion, increase adherence, and thereby may improve outcomes.</description><identifier>ISSN: 0039-6060</identifier><identifier>EISSN: 1532-7361</identifier><identifier>DOI: 10.1016/j.surg.2015.04.056</identifier><identifier>PMID: 26435426</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Female ; Guideline Adherence - standards ; Humans ; Male ; Middle Aged ; Practice Guidelines as Topic - standards ; Surgery ; Thyroid Gland - pathology ; Thyroid Gland - surgery ; Thyroid Neoplasms - pathology ; Thyroid Neoplasms - surgery ; Treatment Outcome</subject><ispartof>Surgery, 2016-01, Vol.159 (1), p.41-51</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c481t-82c7073ef584853a1f05e218541ce7b7edbb69c1b4f02d4f02016c6e64cd2ecc3</citedby><cites>FETCH-LOGICAL-c481t-82c7073ef584853a1f05e218541ce7b7edbb69c1b4f02d4f02016c6e64cd2ecc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0039606015006674$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26435426$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Adam, Mohamed Abdelgadir, MD</creatorcontrib><creatorcontrib>Goffredo, Paolo, MD</creatorcontrib><creatorcontrib>Youngwirth, Linda, MD</creatorcontrib><creatorcontrib>Scheri, Randall P., MD</creatorcontrib><creatorcontrib>Roman, Sanziana A., MD</creatorcontrib><creatorcontrib>Sosa, Julie A., MD, MA</creatorcontrib><title>Same thyroid cancer, different national practice guidelines: When discordant American Thyroid Association and National Comprehensive Cancer Network surgery recommendations are associated with compromised patient outcome</title><title>Surgery</title><addtitle>Surgery</addtitle><description>Background The American Thyroid Association (ATA) and National Comprehensive Cancer Network (NCCN) guidelines have discordant recommendations for managing patients with differentiated thyroid cancer (DTC). We hypothesized that physician adherence to either of the 2009 extent of surgery guidelines of the ATA or NCCN was associated with improved survival, and that practice is most standardized nationally when guidelines are concordant. Methods Adult patients undergoing surgery for DTC were included from the National Cancer Database. Multivariable modeling was used to identify factors associated with nonadherence to the 2009 ATA or NCCN guidelines (2010–2011) and hypothetically examine the association of retrospective adherence to guidelines with survival (1998–2006). Results A total of 39,687 patients with DTC were included; 2,249 were not treated in accordance with ATA or NCCN guidelines. Factors independently associated with nonadherence were discordance between ATA and NCCN recommendations, black race, and treatment at nonacademic centers ( P < .01). After adjustment, care not in accordance with either set of guidelines was associated with compromised survival (hazard ratio 1.16, P = .02). Conclusion A minority of patients received surgery for DTC not aligned with guidelines; nonadherent care was associated with compromised survival. Discordance in recommendations between guidelines is associated with reduction in adherent care, suggesting that standardizing guidelines could decrease confusion, increase adherence, and thereby may improve outcomes.</description><subject>Adult</subject><subject>Female</subject><subject>Guideline Adherence - standards</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Practice Guidelines as Topic - standards</subject><subject>Surgery</subject><subject>Thyroid Gland - pathology</subject><subject>Thyroid Gland - surgery</subject><subject>Thyroid Neoplasms - pathology</subject><subject>Thyroid Neoplasms - surgery</subject><subject>Treatment Outcome</subject><issn>0039-6060</issn><issn>1532-7361</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ks9u1DAQxiMEokvhBTggHzmwwU4cJ4sQ0mrFP6kqhxZxtJzxpOttEm_tpNW-TZ-l78G7MNndcuDAxZas7_t5Zr5JkteCp4IL9X6TxjFcpRkXRcplygv1JJmJIs_mZa7E02TGeb6YK674SfIixg3nfCFF9Tw5yZTMC5mpWfL7wnTIhvUueGcZmB4wvGPWNQ0G7AfWm8H53rRsGwwMDpBdjc5i63qMH9ivNfYkjuCDNaRedhgcQdjlEbiM0YPbM5jp7cP9-SNv5bttQPJHd4tstf-YneNw58M1m_rCsGMBwXcd9nbviswEfLg3RyZadueGNYOJ5DsX6WFLwqlsPw70jC-TZ41pI7463qfJzy-fL1ff5mc_vn5fLc_mICsxzKsMSl7m2BSVrIrciIYXmImqkAKwrEu0da0WIGrZ8MxOB40fFCoJNkOA_DR5e-BSITcjxkFTOYBta3r0Y9SiLIRYKGKTNDtIIfgYAzZ6G1xnwk4LrqdY9UZP7espVs2lpljJ9ObIH-sO7V_LY44k-HgQIHV56zDoCDQIQOtohoO23v2f_-kfO1DClGR7jTuMGz8Gyoz60DHTXF9MizXtlSg4V6qU-R_3UtHr</recordid><startdate>20160101</startdate><enddate>20160101</enddate><creator>Adam, Mohamed Abdelgadir, MD</creator><creator>Goffredo, Paolo, MD</creator><creator>Youngwirth, Linda, MD</creator><creator>Scheri, Randall P., MD</creator><creator>Roman, Sanziana A., MD</creator><creator>Sosa, Julie A., MD, MA</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160101</creationdate><title>Same thyroid cancer, different national practice guidelines: When discordant American Thyroid Association and National Comprehensive Cancer Network surgery recommendations are associated with compromised patient outcome</title><author>Adam, Mohamed Abdelgadir, MD ; Goffredo, Paolo, MD ; Youngwirth, Linda, MD ; Scheri, Randall P., MD ; Roman, Sanziana A., MD ; Sosa, Julie A., MD, MA</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c481t-82c7073ef584853a1f05e218541ce7b7edbb69c1b4f02d4f02016c6e64cd2ecc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Female</topic><topic>Guideline Adherence - standards</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Practice Guidelines as Topic - standards</topic><topic>Surgery</topic><topic>Thyroid Gland - pathology</topic><topic>Thyroid Gland - surgery</topic><topic>Thyroid Neoplasms - pathology</topic><topic>Thyroid Neoplasms - surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Adam, Mohamed Abdelgadir, MD</creatorcontrib><creatorcontrib>Goffredo, Paolo, MD</creatorcontrib><creatorcontrib>Youngwirth, Linda, MD</creatorcontrib><creatorcontrib>Scheri, Randall P., MD</creatorcontrib><creatorcontrib>Roman, Sanziana A., MD</creatorcontrib><creatorcontrib>Sosa, Julie A., MD, MA</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Adam, Mohamed Abdelgadir, MD</au><au>Goffredo, Paolo, MD</au><au>Youngwirth, Linda, MD</au><au>Scheri, Randall P., MD</au><au>Roman, Sanziana A., MD</au><au>Sosa, Julie A., MD, MA</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Same thyroid cancer, different national practice guidelines: When discordant American Thyroid Association and National Comprehensive Cancer Network surgery recommendations are associated with compromised patient outcome</atitle><jtitle>Surgery</jtitle><addtitle>Surgery</addtitle><date>2016-01-01</date><risdate>2016</risdate><volume>159</volume><issue>1</issue><spage>41</spage><epage>51</epage><pages>41-51</pages><issn>0039-6060</issn><eissn>1532-7361</eissn><abstract>Background The American Thyroid Association (ATA) and National Comprehensive Cancer Network (NCCN) guidelines have discordant recommendations for managing patients with differentiated thyroid cancer (DTC). We hypothesized that physician adherence to either of the 2009 extent of surgery guidelines of the ATA or NCCN was associated with improved survival, and that practice is most standardized nationally when guidelines are concordant. Methods Adult patients undergoing surgery for DTC were included from the National Cancer Database. Multivariable modeling was used to identify factors associated with nonadherence to the 2009 ATA or NCCN guidelines (2010–2011) and hypothetically examine the association of retrospective adherence to guidelines with survival (1998–2006). Results A total of 39,687 patients with DTC were included; 2,249 were not treated in accordance with ATA or NCCN guidelines. Factors independently associated with nonadherence were discordance between ATA and NCCN recommendations, black race, and treatment at nonacademic centers ( P < .01). After adjustment, care not in accordance with either set of guidelines was associated with compromised survival (hazard ratio 1.16, P = .02). Conclusion A minority of patients received surgery for DTC not aligned with guidelines; nonadherent care was associated with compromised survival. Discordance in recommendations between guidelines is associated with reduction in adherent care, suggesting that standardizing guidelines could decrease confusion, increase adherence, and thereby may improve outcomes.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26435426</pmid><doi>10.1016/j.surg.2015.04.056</doi><tpages>11</tpages></addata></record> |
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| subjects | Adult Female Guideline Adherence - standards Humans Male Middle Aged Practice Guidelines as Topic - standards Surgery Thyroid Gland - pathology Thyroid Gland - surgery Thyroid Neoplasms - pathology Thyroid Neoplasms - surgery Treatment Outcome |
| title | Same thyroid cancer, different national practice guidelines: When discordant American Thyroid Association and National Comprehensive Cancer Network surgery recommendations are associated with compromised patient outcome |
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