Impact of proximity to health center on adherence to NCCN guidelines in patients with soft tissue sarcomas.

Abstract

e13503 Background: Soft tissue sarcomas (STS) are a rare malignancy, approximately 13,590 new cases are diagnosed annually in the United States. Due to their management complexity, the National Comprehensive Cancer Network (NCCN) has developed evidence-based guidelines to standardize the workup and treatment of STS, aiming to ensure a high quality of care. Despite the established benefits of guideline adherence, factors influencing compliance remain underexplored. This study aims to assess adherence to NCCN guidelines for STS at a single academic institution throughout the year 2023. By evaluating compliance rates and patient proximity to the cancer center, we seek to gain a deeper understanding of the challenges in delivering guideline-concordant care. Methods: Following Institutional Review Board approval, a natural language search was used to identify patients diagnosed with or treated for soft tissue sarcomas (STS) at a single academic institution in 2023. Ninety-one patients were identified. Individuals were included if they received a diagnosis or underwent the majority of their workup or treatment during this period. We then reviewed each patient's workup and treatment plan to evaluate adherence to the NCCN guidelines. This included a proper history & physical, primary site imaging, CNB, chest/abdominal imaging, presentation to our multidisciplinary team, wide margin surgical resection, radiation therapy, and chemotherapy. Estimated travel time was calculated using Google Maps in drive mode. The end point for all calculations was our central downtown academic cancer center, with the starting point being the patient’s home address. Results: A total of 43 patients were included in the study. The most common diagnoses were spindle cell sarcoma and undifferentiated pleomorphic sarcoma (22.73% each). The most common TNM stage was IV (51.16%). All patients (100%) met workup compliance according to the NCCN guidelines. Thirty-four patients (79.07%) completed their treatment course adhering to the NCCN guidelines, while 9 patients (20.93%) fell short. Four (9.30%) passed away while receiving treatment, 3 (6.98%) were recommended for further treatment but declined, and 2 (4.65%) were seen as second opinions and returned to their original provider for treatment. The three cases where further treatment was declined traveled distances of 1.5 miles (8 minutes), 10.9 miles (35 minutes), and 22.5 miles (55 minutes). Travel distance ranged from 1.5 to 201 miles, with a median distance and travel time of 31 miles and 55 minutes. Conclusions: This study demonstrates a high level of compliance with NCCN guidelines for extremity STS at a single academic institution. Distance to the central academic cancer center did not appear to be a significant factor in adherence. Future studies should explore additional variables to better understand the full scope of influences on guideline adherence in sarcoma care.