Institutional adherence to National Comprehensive Cancer Network (NCCN) guidelines in neoadjuvant treatment of breast cancer and its correlation to outcomes.

Document Type

Conference Proceeding

Publication Date


Publication Title

J Clin Oncol


Background: The aim of the study is to assess the adherence to National Comprehensive Cancer Network (NCCN) guidelines in the neoadjuvant treatment of breast cancer and evaluate its correlation to outcomes. Higher adherence rates correlate with improved survival and are a potential measure of the quality of care. Methods: We screened patients who were treated with neoadjuvant chemotherapy at our institution for the years 2015 & 2016, a total 46 patients met the criteria. To evaluate adherence we tabulated 8 adherence categories per NCCN. We then screened patients who were only eligible to receive the treatment specific to a certain adherence category. A total adherence rate was calculated by dividing the number of categories for which they underwent intervention by the total number of eligible adherence categories. Rates of pathologic complete response (PCR) and Breast Conservation surgery (BCS) were calculated to measure the outcomes. Results: We had 9 triple negative breast cancer (TNBC), 28 Her2 overexpression (Her2+) and 17 triple positive patients. We had 100% adherence in categories such as, appropriate prechemotherapy evaluation {total eligible patients, n = 46}, completeness of histopathology report (n = 46), use of anti-Her2 antibody drug in patients with Her2 overexpression positive by IHC or FISH (n = 28) and adjuvant radiation therapy (n = 39). In the following categories, adherence rates were as follows, 70% (n = 33) genetic consult, 69% (n = 32) reconstructive surgery, 65% (n = 46) cancer distress screen performed. We could not assess the adherence to reproductive gynecology consult. Our median total adherence rates were 85% for all of the adherence categories in eligible patients. We had PCR and BCS rates of 39% & 41% respectively. Further analysis showed PCR & BCS rates of 46% & 39% in Her2+ patients, 33% & 44% in TNBC patients, 35% & 38% in Doxorubicin treatment and 46% & 39% in anti-Her2 antibody treatment group respectively. Conclusions: Our study shows adherence to NCCN guidelines leads to improved outcomes. To improve quality of care, institutions should closely monitor the adherence to NCCN or other alternative national guidelines.





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