Table 4.
Adherence to cancer-specific process of care guidelines in non-Hispanic White and American Indian/Alaska Native patients.
| CANCER-SPECIFIC PROCESS MEASURES a | Percent adherence in NHW b, % |
Percent adherence in AI/AN c, % |
p-value d |
|---|---|---|---|
| BREAST | n = 801 | n =44 | |
| Preoperative core needle biopsy | 94.3 | 81.4 | 0.004 |
| Hormone receptor status reported | 99.1 | 91.9 | 0.008 |
| Lymph node evaluation (invasive cancer) | 88.1 | 84.9 | 0.58 |
| ALND e for node-positive mastectomy patients | 74.1 | 73.3 | 0.58 |
|
Mean adherence across breast cancer measures f (95% CI) |
92.0% (90.8%, 93.2%) |
86.0% (78.5%, 93.5%) |
0.13 g |
| COLON | n = 3,037 | n = 45 | |
| ≥12 nodes evaluated | 88.2 | 79.1 | 0.09 |
| Bowel prep before surgery | 98.0 | 100.0 | 0.68 |
| Anastomosis tested | 61.2 | 68.4 | 0.41 |
| Negative resection margins | 95.9 | 95.6 | 0.71 |
|
Mean adherence across colon cancer measures f (95% CI) |
83.7% (83.0% – 84.4%) |
83.7% (77.0% – 90.4%) |
0.79 g |
| LUNG | n = 489 | n = 11 | |
| Multidisciplinary evaluation before surgery | 65.7 | 83.3 | 0.67 |
| Preoperative PFT h documented | 87.1 | 100.0 | 0.37 |
| ≥3 lymph node basins sampled | 83.3 | 100.0 | 0.41 |
| Smoking cessation counseling (if current smoker) | 69.8 | 50.0 | 0.37 |
|
Mean adherence across lung cancer measures f (95% CI) |
80.9% (78.4% – 83.5%) |
87.1% (74.5% – 99.7%) |
0.68 g |
| PROSTATE | n = 593 | n = 14 | |
| PSAi documented preoperatively | 98.5 | 100.0 | 0.81 |
| Potency documented preoperatively | 75.9 | 36.4 | 0.007 |
| Urinary continence documented preoperatively | 89.7 | 50.0 | 0.002 |
| Gleason score and pathologic stage reported | 99.7 | 92.9 | 0.07 |
|
Mean adherence across prostate cancer measures f (95% CI) |
91.6% (90.0% – 92.6%) |
74.4% (60.5% – 88.3%) |
0.001 g |
| OVERALL CANCER a | n = 4920 | n = 114 | |
|
Mean adherence across all four cancer measures f (95% CI) |
85.7% (85.1% – 86.3%) |
83.8% (79.5% – 88.1%) |
0.64 g |
Process measures were evaluated for all non-Hispanic White and American Indian/Alaska Native patients who received inpatient operations for breast, colon, lung, and prostate cancers.
. NHW: non-Hispanic White.
. AI/AN: American Indian and Alaska Native.
. Reported as Fisher's exact test for difference in frequency between non-Hispanic Whites and American Indians/Alaska Natives unless otherwise stated.
. ALND: axillary lymph node dissection.
. Percentage adherence was calculated across metrics for which a patient was eligible (e.g., non-smoking patients were not eligible for smoking cessation counseling).
. Reported as two-sample Wilcoxon rank-sum (Mann-Whitney) test for differences.
. PFT: pulmonary function tests.
. PSA: prostate-specific antigen test.