Help
Subscribe


All of GastroHep is now free access! - Click here to register Read For FREE - Our full range of review articles
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Guido Tytgat Profile of Pete Peterson Profile of Peter Cotton Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Interinstitutional variation in management decisions for colorectal cancer

This month's issue of the Annals of Internal Medicine reports interinstitutional variation in management decisions for treatment of common types of cancer.

News image

When clinical practice is governed by evidence-based guidelines and there is consensus about their validity, practice variation should be minimal.

For areas in which evidence gaps exist, greater variation is expected.

Dr Jane Weeks and colleagues systematically assessed interinstitutional variation in management decisions for 4 common types of cancer.

The team performed a multi-institutional, observational cohort study of patients with cancer diagnosed between 2006 through 2011.

The researchers evaluated 18 cancer centers participating in the formulation of treatment guidelines and systematic outcomes assessment through the National Comprehensive Cancer Network.

The team identified 25,589 patients with incident breast cancer, colorectal cancer, lung cancer, or non-Hodgkin lymphoma.

Interinstitutional variation was high for 20% of oncology management decisions
Annals of Internal Medicine

Interinstitutional variation for 171 binary management decisions with varying levels of supporting evidence.

For each decision, variation was characterized by the median absolute deviation of the center-specific proportions.

The team observed that interinstitutional variation was high for 20% of oncology management decisions, including 41% of decisions for non-Hodgkin lymphoma, 21% for breast cancer, 15% for lung cancer, and 12% for colorectal cancer.

The researchers noted that 46% of high-variance decisions involved imaging or diagnostic procedures, and 37% involved choice of chemotherapy regimen.

The evidence grade underpinning the 35 high-variance decisions was category 1 for 0%, 2A for 49%, and 2B/other for 51%.

Dr Weeks' team comments, "The substantial variation in institutional practice manifest among cancer centers reveals a lack of consensus about optimal management for common clinical scenarios."

"For clinicians, awareness of management decisions with high variation should prompt attention to patient preferences."

"For health systems, high variation can be used to prioritize comparative effectiveness research, patient–provider education, or pathway development."

Ann Intern Med 2014;161(1):20-30
15 July 2014

Go to top of page Email this page Email this page to a colleague

 27 August 2014

Advanced search
 27 August 2014 
Hepatocellular carcinoma screening in liver disease
 27 August 2014 
Endoscopy outcomes in community hospital vs tertiary academic centers
 27 August 2014 
UV exposure and IBD hospitalizations
 26 August 2014 
NAFLD and gastroesophageal reflux symptoms
 26 August 2014 
Adalimumab-treated patients with ulcerative colitis
 26 August 2014 
Wound healing after abdominoperineal resection
 25 August 2014 
Surgical management of rectourethral fistulas
 25 August 2014 
Biomarker analysis in biopsies for ulcerative colitis
 25 August 2014 
Ileocolic resection in Crohn's disease
 22 August 2014 
Outlier identification in colorectal surgery
 22 August 2014 
Endoscopic submucosal dissection for squamous esophageal cancer
 22 August 2014 
Adherence to Rome criteria in functional dyspepsia trials
 21 August 2014 
Screening for Barrett’s esophagus
 21 August 2014 
Colorectal cancer mortality in Brazil
 21 August 2014 
Eosinophilic esophagitis
 20 August 2014 
Rectal surgery mortality
 20 August 2014 
Chemotherapy-induced gastrointestinal mucositis
 20 August 2014 
Stool methylated DNA markers and colorectal cancer resection
 19 August 2014 
Recurrent C. difficile infection in out-patients
 19 August 2014 
Racial disparities and colon cancer
 19 August 2014 
Variability of colonoscopy preparation instructions
 18 August 2014 
The evolution of urban C. difficile
 18 August 2014 
Metabolomic analysis in IBD
 18 August 2014 
Enhanced T-cell response in acute-on-chronic Hep B
 15 August 2014 
Abdominal pain in IBS
 15 August 2014 
Gene expression biomarker in ulcerative colitis
 15 August 2014 
Population-based fecal immunochemical test screening
 14 August 2014 
Transnasal vs transoral endoscopy
 14 August 2014 
Radiation exposure in gastroenterology
 14 August 2014 
Dietary fibre and diverticular disease
 13 August 2014 
Adherence to Rome criteria in functional dyspepsia
 13 August 2014 
Fecal immunochemical test screening
 13 August 2014 
Flexible sigmoidoscopy screening
 12 August 2014 
Eosinophilic esophagitis and celiac disease
 12 August 2014 
Management of Lynch syndrome
 12 August 2014 
Risk of cancer under immunosuppressive therapy in IBD
 11 August 2014 
Gut microbiota in chemotherapy-induced GI mucositis
 11 August 2014 
Risk of GI bleeds with anticoagulants
 11 August 2014 
Social media in health-care
 08 August 2014 
Endoscopy nurse-administered propofol sedation performance
 08 August 2014 
Therapy for biliary tract cancer
 08 August 2014 
Surgeon volume and esophagectomy survival
 07 August 2014 
Global consensus on perianal fistulizing Crohn's disease
 07 August 2014 
Smoking cessation and age of onset of ulcerative colitis
 07 August 2014 
Colonoscopy length and training duration
 06 August 2014 
Hepatitis C virus infection in the United States
 06 August 2014 
Pediatric to adult IBD care
 06 August 2014 
Biomarker of disease activity in IBD
 05 August 2014 
Rising incidence of celiac disease
 05 August 2014 
Socioeconomic status and IBS
 05 August 2014 
Bowel dysfunction after sphincter-preserving rectal cancer surgery
 04 August 2014 
Relative adrenal insufficiency and chronic liver disease
 04 August 2014 
Colonoscopy screening protocol for liver transplant recipients
 04 August 2014 
Patient-reported outcomes after upper GI bleed
 01 August 2014 
Capsule colonoscopy vs CT colonography for polyp screening
 01 August 2014 
Complications after obesity surgery
 01 August 2014 
Fully covered self-expanding metal stents for benign biliary strictures
 31 July 2014 
Biomarkers in liver fibrosis
 31 July 2014 
Risk factors of large colorectal polyps
 31 July 2014 
Diverticular disease and colon cancer

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2014 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us