Comparing current care to the NCCN prostate cancer practice guidelines

The National Comprehensive Cancer Network (NCCN) Prostate Cancer Practice Guidelines were developed to improve the consistency of prostate cancer care within the 17 NCCN institutions To have an effect on the quality of patient care, guideline recommendations must be an improvement over current pr actice. To determine if, and how, current practice differs from recommendations published in the guidelines at baseline, we made a comparison of the patterns of care. A total of 143 patient visits to urology, medical oncology, and radiation oncology clinics were evaluated Current physician practices were assessed against guideline recommendations at each point of a patient's care: staging work -up, initial therapy, surveillance, salvage work-up primary salvage therapy, sequential androgen ablative therapy, and androgen-independent salvage therapy. Overall baseline compliance was 63% but this estimate varied with the stages of a patients care. Physicians practices were more aligned,with "therapeutic" recommendations than with "diagnostic" recommendations (94%vs 64%, P =.001). Radiation onocologists and medical onocologists were 10.7 and 4.5 times, respectively, more likely to comply with the NCCN guidelines than were urologists. We conclude that implementation of these guidelines would result It in a potential for significant modification of current practice patterns, particularly with respect to "diagnostic "practices.