Adherence to Clinical Practice Guidelines and Colorectal Cancer Survival: A Retrospective High-Resolution Population-Based Study in Spain

Francisco Carrasco-Peña, Eloisa Bayo-Lozano, Miguel Rodríguez-Barranco, Dafina Petrova, Rafael Marcos-Gragera, Maria Carmen Carmona-Garcia, Josep Maria Borras and Maria-José Sánchez
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Francisco Carrasco-Peña: Radiation Oncology Department, University Hospital Virgen Macarena, 41009 Sevilla, Spain
Eloisa Bayo-Lozano: Radiation Oncology Department, University Hospital Virgen Macarena, 41009 Sevilla, Spain
Miguel Rodríguez-Barranco: Escuela Andaluza de Salud Pública, 18011 Granada, Spain
Dafina Petrova: Escuela Andaluza de Salud Pública, 18011 Granada, Spain
Rafael Marcos-Gragera: CIBER de Epidemiologia y Salud Pública (CIBERESP), 28029 Madrid, Spain
Maria Carmen Carmona-Garcia: Descriptive Epidemiology, Genetics and Cancer Prevention Group, Girona Biomedical Research Institute—IDIBGI, Salt, 17190 Girona, Spain
Josep Maria Borras: Department of Clinical Sciences, IDIBELL, University of Barcelona, Hospitalet, 08908 Barcelona, Spain
Maria-José Sánchez: Escuela Andaluza de Salud Pública, 18011 Granada, Spain

IJERPH, 2020, vol. 17, issue 18, 1-15

Abstract: Colorectal cancer (CRC) is the third most common cancer worldwide. Population-based, high-resolution studies are essential for the continuous evaluation and updating of diagnosis and treatment standards. This study aimed to assess adherence to clinical practice guidelines and investigate its relationship with survival. We conducted a retrospective high-resolution population-based study of 1050 incident CRC cases from the cancer registries of Granada and Girona, with a 5-year follow-up. We recorded clinical, diagnostic, and treatment-related information and assessed adherence to nine quality indicators of the relevant CRC guidelines. Overall adherence (on at least 75% of the indicators) significantly reduced the excess risk of death (RER) = 0.35 [95% confidence interval (CI) 0.28–0.45]. Analysis of the separate indicators showed that patients for whom complementary imaging tests were requested had better survival, RER = 0.58 [95% CI 0.46–0.73], as did patients with stage III colon cancer who underwent adjuvant chemotherapy, RER = 0.33, [95% CI 0.16–0.70]. Adherence to clinical practice guidelines can reduce the excess risk of dying from CRC by 65% [95% CI 55–72%]. Ordering complementary imagining tests that improve staging and treatment choice for all CRC patients and adjuvant chemotherapy for stage III colon cancer patients could be especially important. In contrast, controlled delays in starting some treatments appear not to decrease survival.

Keywords: colorectal cancer; adherence; clinical practice guidelines; population-based study; high-resolution study; cancer survival (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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