Population-Based Analysis of National Comprehensive Cancer Network (NCCN) Guideline Adherence for Patients with Anal Squamous Cell Carcinoma in California

SIMPLE SUMMARY: Oncology-specific evidence-based treatment guidelines aim to improve cancer care. Less is known about the effect of guideline adherence on anal squamous cell carcinoma outcomes. Our study aimed to analyze adherence to the National Comprehensive Cancer Network treatment guidelines for anal squamous cell carcinoma in California and the associated impacts on survival. From our retrospective analysis, we found those with male sex, Medicaid insurance, and low socioeconomic status were less likely to receive adherent care. Race/ethnicity was not associated with receipt of adherent care. Adherent care was also associated with improved overall and disease-specific survival. Our study further contributes to the literature that shows guideline-adherent care improves cancer outcomes. Further efforts must therefore be made to increase guideline adherence in anal squamous cell carcinoma, especially in vulnerable populations. ABSTRACT: Purpose: We analyzed adherence to the National Comprehensive Cancer Network treatment guidelines for anal squamous cell carcinoma in California and the associated impacts on survival. Methods: This was a retrospective study of patients in the California Cancer Registry aged 18 to 79 years with recent diagnoses of anal squamous cell carcinoma. Predefined criteria were used to determine adherence. Adjusted odds ratios and 95% confidence intervals were estimated for those receiving adherent care. Disease-specific survival (DSS) and overall survival (OS) were examined with a Cox proportional hazards model. Results: 4740 patients were analyzed. Female sex was positively associated with adherent care. Medicaid status and low socioeconomic status were negatively associated with adherent care. Non-adherent care was associated with worse OS (Adjusted HR 1.87, 95% CI = 1.66, 2.12, p < 0.0001). DSS was worse in patients receiving non-adherent care (Adjusted HR 1.96, 95% CI = 1.56, 2.46, p < 0.0001). Female sex was associated with improved DSS and OS. Black race, Medicare/Medicaid, and low socioeconomic status were associated with worse OS. Conclusions: Male patients, those with Medicaid insurance, or those with low socioeconomic status are less likely to receive adherent care. Adherent care was associated with improved DSS and OS in anal carcinoma patients.