Comparing current care to the NCCN prostate cancer practice guidelines

The National Comprehensive Cancer Network (NCCN) Prostate Cancer Practice G uidelines were developed to improve the consistency of prostate cancer care within the 17 NCCN institutions To have an effect on the quality of patien t care, guideline recommendations must be an improvement over current pr ac tice. To determine if, and how, current practice differs from recommendatio ns published in the guidelines at baseline, we made a comparison of the pat terns of care. A total of 143 patient visits to urology, medical oncology, and radiation oncology clinics were evaluated Current physician practices w ere assessed against guideline recommendations at each point of a patient's care: staging work -up, initial therapy, surveillance, salvage work-up pri mary salvage therapy, sequential androgen ablative therapy, and androgen-in dependent salvage therapy. Overall baseline compliance was 63% but this est imate varied with the stages of a patients care. Physicians practices were more aligned,with "therapeutic" recommendations than with "diagnostic" reco mmendations (94%vs 64%, P =.001). Radiation onocologists and medical onocol ogists were 10.7 and 4.5 times, respectively, more likely to comply with th e NCCN guidelines than were urologists. We conclude that implementation of these guidelines would result It in a potential for significant modificatio n of current practice patterns, particularly with respect to "diagnostic "p ractices.