Lymph node evaluation for colon cancer in an era of quality guidelines: Who improves?

Helen M. Parsons, James W. Begun, Karen M. Kuntz, Todd M. Tuttle, Patricia M. McGovern, Beth A. Virnig

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Introduction: In the 1990s, several organizations began recommending evaluation of > 12 lymph nodes during colon resection because of its association with improved survival. We examined practice implications of multispecialty quality guidelines over the past 20 years recommending evaluation of ≥ 12 lymph nodes during colon resection for adequate staging. Materials and Methods: We used the 1988 to 2009 Surveillance, Epidemiology, and End Results program to conduct a retrospective observational cohort study of 90,203 surgically treated patients with colon cancer. We used Cochran-Armitage tests to examine trends in lymph node examination over time and multivariate logistic regression to identify patient characteristics associated with guideline-recommended lymph node evaluation. Results: The introduction of practice guidelines was associated with gradual increases in guideline-recommended lymph node evaluation. From 1988 to 1990, 34% of patients had > 12 lymph nodes evaluated, increasing to 38% in 1994 to 1996 and to > 75% from 2006 to 2009. Younger, white patients and those with more-extensive bowel penetration (T3/4 nonmetastatic) and high tumor grade saw more-rapid increases in lymph node evaluation (P <. 001). Multivariate analyses demonstrated a significant interaction between year of diagnosis and both T stage and grade, indicating that those with higher T stage and higher grade were more likely to receive guideline-recommended care earlier. Conclusion: The implementation of lymph node evaluation guidelines was accepted gradually into practice but adopted more quickly among higher risk patients. By identifying patients who are least likely to receive guideline-recommended care, these findings present a starting point for promoting targeted improvements in cancer care and further understanding underlying contributors to these disparities.

Original languageEnglish (US)
JournalJournal of Oncology Practice
Volume9
Issue number4
DOIs
StatePublished - Jul 2013

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Colonic Neoplasms
Lymph Nodes
Guidelines
Colon
SEER Program
Practice Guidelines
Observational Studies
Neoplasms
Cohort Studies
Multivariate Analysis
Logistic Models
Survival

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)
  • Health Policy

Cite this

Parsons, H. M., Begun, J. W., Kuntz, K. M., Tuttle, T. M., McGovern, P. M., & Virnig, B. A. (2013). Lymph node evaluation for colon cancer in an era of quality guidelines: Who improves? Journal of Oncology Practice, 9(4). https://doi.org/10.1200/JOP.2012.000812

Lymph node evaluation for colon cancer in an era of quality guidelines : Who improves? / Parsons, Helen M.; Begun, James W.; Kuntz, Karen M.; Tuttle, Todd M.; McGovern, Patricia M.; Virnig, Beth A.

In: Journal of Oncology Practice, Vol. 9, No. 4, 07.2013.

Research output: Contribution to journalArticle

Parsons, Helen M. ; Begun, James W. ; Kuntz, Karen M. ; Tuttle, Todd M. ; McGovern, Patricia M. ; Virnig, Beth A. / Lymph node evaluation for colon cancer in an era of quality guidelines : Who improves?. In: Journal of Oncology Practice. 2013 ; Vol. 9, No. 4.
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