Download Table 1. Percentage of Resected NSCLC Stage II and IIIA Patients T

Table 1. Percentage of Resected NSCLC Stage II and IIIA Patients Treated with Practice Guideline Recommended
Adjuvant Chemotherapy Following Surgery by Local Health Integration Network (LHIN) Region of Residence
(patients diagnosed in 2009).
LHIN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Ontario
Guideline
Treatment (RCC)
32%
38%
16%
46%
10%
32%
29%
40%
49%
52%
61%
37%
50%
65%
41%
Treated Non-RCC
6%
4%
19%
2%
41%
27%
32%
25%
11%
4%
1%
24%
4%
0%
14%
Alternate
Treatment
3%
4%
19%
7%
10%
5%
5%
3%
6%
11%
7%
11%
4%
10%
7%
No Treatment <120
Days of Surgery
59%
53%
47%
46%
38%
35%
34%
32%
34%
33%
31%
28%
42%
25%
38%
Total Resected
II&IIIA Cases
34
68
43
61
29
37
65
68
83
27
72
46
50
20
703
NSCLC, non-small cell lung cancer; RCC, Regional Cancer Centre
Report date: December, 2011
Data source: Cancer Care Ontario, ALR, OCR
Notes:
 Many patients in the "No Treatment" category may not be medically fit for the practice guideline treatment due to factors we are not currently
able to adjust for. Patients may also decline treatment for personal reasons. Others may have been treated outside Ontario.
 Alternate Treatment: cases receiving a therapy different from that recommended in the practice guidelines. This may include non-platinumbased chemotherapy or radiation therapy only.
 Treated Non RCC: patients receiving chemotherapy outside of a cancer centre where the drug regimen is not reported to Cancer Care
Ontario (CCO).
Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information. However, the analyses, conclusions, opinions and
statements expressed herein are those of the author, and not necessarily those of the Canadian Institute for Health Information.
Table 2. Percentage of Unresected NSCLC Stage IIIA and IIIB Patients Treated with Practice Guideline
Recommended Chemo-radiation Therapy by Local Health Integration Network (LHIN) Region of Residence
(patients diagnosed in 2009).
LHIN
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Ontario
Guideline
Treatment (RCC)
36%
35%
25%
25%
6%
21%
10%
12%
21%
34%
32%
19%
28%
18%
25%
Treated Non-RCC
Alternate Treatment
6%
6%
13%
1%
6%
11%
16%
15%
12%
0%
2%
11%
6%
3%
7%
27%
24%
34%
41%
39%
32%
35%
27%
25%
35%
41%
38%
46%
50%
34%
No Treatment<180
Days of Diagnosis
31%
34%
28%
33%
48%
36%
38%
46%
41%
31%
25%
32%
20%
29%
34%
Total Nonresected
IIIA & IIIB Cases
84
140
53
181
31
85
79
95
138
68
128
47
69
38
1,236
NSCLC, non-small cell lung cancer; RCC, Regional Cancer Centre
Report date: November, 2011
Data source: Cancer Care Ontario, ALR, OCR
Notes:
 "No Treatment" does not necessarily indicate inappropriate care. Many patients may not be medically fit for the practice guideline treatment
due to factors we are not currently able to measure. Some patients may also decline treatment for a variety of personal reasons. Others may
have been treated outside Ontario.
 Alternate Treatment: cases receiving a therapy different from that recommended in the practice guidelines. This may include non-platinumbased chemotherapy or chemotherapy only or radiation therapy only.
 Treated Non-RCC: patients receiving chemotherapy outside of a cancer centre where the drug regimen is not reported to Cancer Care Ontario
(CCO).
Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information. However, the analyses, conclusions, opinions and
statements expressed herein are those of the author, and not necessarily those of the Canadian Institute for Health Information
Table 3. Practice Guideline A: Resected NSCLC Stage II and IIIA Patients
ITEM
Assessment of the Recommendations
a. Aware of the recommendations
b. Agree with the recommendations
c. Recommendations are unambiguous
d. Recommendations are supported by the evidence
e. Recommendations are current
f. Recommendations are easy to apply in their clinical
context
g. Recommendations are too rigid for the patients they
are intended
h. Recommendations do not align with how they typically
manage these patients
i. Recommendations apply to the patients they target
j. Recommendations are biased
k. Support for the recommendations
l. Clinical practice of respondent aligns with the
recommendations
Assessment of the Evidentiary Base
a. It is complete
b. It is convincing
c. It is informative
d. It is relevant to typical patients
e. It is strong
f. It is current
RATING PERCENT A
DISAGREE NEUTRAL AGREE
a
SD
MODE
4.9
5.0
7.5
2.5
7.7
2.6
2.4
0
7.5
0
2.6
10.3
92.7
95.0
85.0
97.5
89.7
87.2
6.3
6.3
5.9
6.4
6.0
6.2
1.2
1.1
1.5
0.9
1.3
1.3
7.0
7.0
7.0
7.0
6.0
7.0
68.4
10.5
21.1
2.9
1.8
2.0
80.0
5.0
15.0
2.4
1.8
1.0a
7.9
82.9
5.0
5.0
0
9.8
2.5
5.0
92.1
7.3
92.5
90.0
6.0
2.0
6.3
6.2
1.3
1.6
1.1
1.1
6.0
1.0
7.0
7.0
7.7
2.6
7.5
12.5
5.3
10.5
5.1
5.1
0
2.5
2.6
2.6
87.2
92.3
92.5
85.0
92.1
86.8
6.0
6.1
6.1
6.0
5.9
5.8
1.2
1.0
1.2
1.6
1.2
1.5
7.0
7.0
7.0
7.0
6.0
6.0a
NSCLC, non-small cell lung cancer
A
MEAN
Disagree (ratings 1 to 3 on 7-point scale); Neutral (rating 4 on 7-point scale); Agree (rating 5 to 7 on 7-point scale)
Multiple mode exists. The smallest value is shown.
Table 4: Practice Guideline B: Unresected NSCLC Stage IIIA and IIIB Patients
ITEM
Assessment of the Recommendations
a. Aware of the recommendations
b. Agree with the recommendations
c. Recommendations are unambiguous
d. Recommendations are supported by the evidence
e. Recommendations are current
f. Recommendations are easy to apply in their clinical
context
g. Recommendations are too rigid for the patients they are
intended
h. Recommendations do not align with how they typically
manage these patients
i. Recommendations apply to the patients they target
j. Recommendations are biased
k. Support for the recommendations
l. Clinical practice of respondent aligns with the
recommendations
Assessment of the Evidentiary Base
a. It is complete
b. It is convincing
c. It is informative
d. It is relevant to typical patients
e. It is strong
f. It is current
RATING PERCENTAGEA
DISAGREE NEUTRAL AGREE
SD
MODE
10.0
5.4
5.3
5.3
2.6
5.3
2.5
5.4
7.9
2.6
10.5
7.9
87.5
89.2
86.8
92.1
86.8
86.8
6.0
6.0
5.8
5.9
5.8
5.8
1.6
1.2
1.2
1.0
1.2
1.3
7.0
7.0
6.0
6.0
6.0
6.0
76.3
5.3
18.4
2.8
1.7
2.0
81.6
7.9
10.5
2.3
1.5
2.0
2.6
89.7
2.6
2.6
5.3
10.3
7.7
7.7
92.1
0
89.7
89.7
5.9
1.8
6.1
6.1
1.0
0.9
1.0
1.0
6.0
2.0
6.0a
6.0
5.3
2.6
2.6
2.6
5.4
5.3
13.2
10.5
7.9
2.6
13.5
18.4
81.6
86.8
89.5
94.7
81.1
76.3
5.7
5.7
5.9
5.9
5.5
5.7
1.3
1.2
1.2
1.1
1.3
1.4
6.0
5.0a
7.0
7.0
6.0
7.0
NSCLC, non-small cell lung cancer
A
MEAN
Disagree (ratings 1 to 3 on 7-point scale); Neutral (rating 4 on 7-point scale); Agree (rating 5 to 7 on 7-point scale)
Table 5. Barrier Analysis
ITEM
a. Surgeons are reluctant to refer patients to a medical
oncologist and/or radiation oncologist.
b. The referral process to a cancer centre or cancer specialist is
complex.
c. The referral process to a cancer centre or cancer specialist is
slow.
d. The referral process to a cancer centre or cancer specialist is
unreliable.
e. Personal lack of clinical skill to implement the
recommendations.
f. Organizational support from the clinical administrator leaders
exists in the institution to support the implementation of the
recommendations.
g. There is adequate medical expertise in their region to
implement the recommendations.
h. The patients in the studies comprising the evidentiary base
do not reflect the typical patient they seen in the clinic.
i. It is easy for patients in their region to access the
recommended treatment
j. The implementation of the recommendations will result in
unacceptable levels of adverse effects for the typical
resected stage II and IIIA NSCLC patients seen in practice.
k. Optimizing the treatment of lung cancer patients is not as
much of an organizational priority in their care setting as is
the treatment of patients with other cancer diagnoses.
l. The implementation of the recommendations will yield the
anticipated benefits as per the recommendations/guideline.
m. The recommendations are not cost effective.
a
Multiple mode exists. The smallest value is shown.
RATING
DISAGREE NEUTRAL
85.0
2.5
MEAN
SD
MODE
AGREE
12.5
1.8
1.4
1.0
76.2
11.9
11.9
2.5
1.6
1.0
53.8
15.4
30.8
3.6
1.8
3.0
82.5
7.5
10.0
2.3
1.5
1.0
90.2
4.9
4.9
1.6
1.3
1.0
31.7
9.8
58.5
4.5
2.3
6.0a
9.3
4.7
86.0
6.1
1.6
7.0
60.0
15.0
25.0
3.1
1.8
2.0
23.1
5.1
71.8
5.1
1.6
5.0a
86.5
10.8
2.7
2.1
1.1
2.0
66.7
17.9
15.4
2.6
1.7
1.0
66.7
17.9
15.4
2.8
1.6
2.0
77.5
15.0
7.5
2.4
1.3
1.0
Table 6. Discipline Specific Analysis
On average __________, are knowledgeable about the evidence for Guideline A.
a) Surgeons
b) Medical oncologists
c) Radiation oncologists
69% agree
81% agree
82% agree
On average __________, are convinced by the evidence of Guideline A.
a) Surgeons
b) Medical oncologists
c) Radiation oncologists
73% agree
82% agree
82% agree
On average __________, support the recommendations of Guideline A.
a) Surgeons
b) Medical oncologists
c) Radiation oncologists
73% agree
78% agree
78% agree
On average __________, are knowledgeable about the evidence for Guideline B.
a) Surgeons
b) Medical oncologists
c) Radiation oncologists
69% agree
82% agree
86% agree
On average __________, are convinced by the evidence of Guideline B.
a) Surgeons
b) Medical oncologists
c) Radiation oncologists
77% agree
81% agree
82% agree
On average __________, support the recommendations of Guideline B.
a) Surgeons
b) Medical oncologists
c) Radiation oncologists
72% agree
82% agree
82% agree