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Trends in the use of evidence‐based therapy for resectable gastric cancer
Author(s) -
Snyder Rebecca A.,
Penson David F.,
Ni Shenghua,
Koyama Tatsuki,
Merchant Nipun B.
Publication year - 2014
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23635
Subject(s) - medicine , randomized controlled trial , cancer , retrospective cohort study , cohort , chemotherapy , adjuvant therapy , stage (stratigraphy) , propensity score matching , oncology , surgery , paleontology , biology
Background and Objectives Two pivotal randomized controlled trials (RCTs), the Intergroup (INT‐0116) and Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trials, demonstrated a survival benefit of multimodality therapy in patients with resectable gastric cancer. The purpose of this study was to determine utilization rates of these treatment regimens in the United States and to identify factors associated with receipt of evidence‐based care. Methods We performed a retrospective cohort study of patients with Stage IB–IV (M0) gastric adenocarcinoma who underwent resection from 1991 to 2009 using the linked SEER–Medicare database. Results Only 19.1% of patients received post‐operative chemoradiation therapy (CRT), and 1.9% received peri‐operative chemotherapy; most patients underwent surgery alone (60.9%). Patients with more advanced stage, younger age, and fewer comorbidities were more likely to receive evidence‐based care. We found no association between National Cancer Institute (NCI) designation and delivery of multimodality therapy. However, patients who underwent medical oncology consultation were much more likely to receive evidence‐based treatment (OR 3.10, 95% CI 2.35–4.09). Conclusions Rates of peri‐operative chemotherapy and post‐operative CRT in patients with resected gastric cancer remain remarkably low, despite high‐quality RCT evidence demonstrating their benefit. Furthermore, NCI designation does not appear to be associated with administration of evidence‐based treatment. J. Surg. Oncol. 2014 110:285–290 . © 2014 Wiley Periodicals, Inc.