Adherence to Colorectal Cancer Treatment Guidelines in Northeastern Appalachia.

摘要

Colorectal cancer is the third most common cancer in the United States, accounting for approximately 140,000 new diagnoses and 60,000 deaths each year. In Appalachia, the colorectal cancer incidence rate per 100,000 persons is significantly higher than it is in the rest of the United States. Previous studies have suggested that adherence to clinical treatment guidelines significantly improves patient outcomes. This study quantified the extent to which colorectal cancer patients in a northeast Pennsylvania section of Appalachia were treated according to consensus-based, national treatment guidelines. In addition, the study attempted to identify patient characteristics that were associated with receiving guideline-adherent treatment. Andersen's Behavioral Model of Health Services Use provided the study's conceptual framework. The study used a retrospective cohort design, drawing on cancer registry records collected between 2000 and 2009. Data were subjected to one-sample z tests for proportions, chi-square tests, and multivariate logistic regression analysis. The rate of guideline adherence was calculated to be 79.2% for the study population. Four patient characteristics were significant factors that influenced the odds of receiving guideline-adherent treatment: age, race/ethnicity, stage at diagnosis, and anatomic site of tumor. The implications for positive social change include improvements in cancer care, longer life, better quality of life, and faster return to a productive role in society for thousands of cancer patients and their caregivers in a sub region of Appalachia.