1. Adherence to the guidelines increased from 38% to 56% between Fall 2016 and 2019; and from 37% to 70% between Spring 2017 and 2019.

2. Confusion over which practitioner is responsible for obtaining imaging is one of the reasons for reduced adherence to the recommendations.

Evidence Rating Level: 3 (Average)

Study Rundown: Current guidelines for the management of rectal cancer recommend pre-treatment staging via pelvic magnetic resonance imaging (MRI) or endorectal ultrasound. This study aimed to determine whether providers were performing initial staging imaging for rectal cancer prior to surgery or starting therapy, and if not, the reasons for that. While adherence to the guideline-recommendations increased from 38% to 56% between Fall 2016 and Fall 2019 and from 37% to 70% between Spring 2017 and Spring 2019, survey feedback indicated ongoing confusion amongst practices concerning which practitioner should order the scans. Limited awareness regarding appropriate scans was also provided as a reason for the discordance with the recommendations. Limitations to this study include the small sample size and the integrity of the data due to self-reported survey responses by the practices. Overall, it was found that adherence to the recommendations was increasing over time, however, a focus on quality improvement is needed as up to 50% of patients are still not receiving imaging prior to treatment.

Click to read the study in The Journal of Clinical Oncology

Relevant Reading: Neoadjuvant radiotherapy for rectal cancer management

In-Depth [survey]: This quality improvement study performed in the United States explored the adherence to the guideline recommendations for imaging in rectal cancer pre-treatment staging. Seven different time points were examined for appropriate initial rectal cancer staging between 2016 and 2019 and between 20 and 33 practices responded at each time point. The data for 1,158 unique patients was included. Adherence was shown to be increasing: in Fall 2016, 38% of patients were provided initial staging as per the guidelines (95% confidence interval (CI), 28-48%), compared to 56% in Fall 2019 (95% CI, 45-67%). In Spring of 2017, 37% of patients received guideline-recommended staging (95% CI, 28-46%) compared to 70% in Spring 2019 (95% CI, 61-78%). Nonconcordance was attributed by practices primarily due to an absence of coordination between providers such as the surgery and oncology providers (16 of 28 practices, or 57.1%). Another contributing factor was limited awareness of appropriate scans for initial staging (8 of 28 practices, or 28.6%).

Image: PD

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