Lack of adherence image

From Cancer Therapy Advisor

Lack of adherence to treatment guidelines for non-small cell lung cancer shown to be significant in recent study. Nearly one-third of patients with nonoperative, node-negative non-small cell lung cancer (NSCLC) did not receive guideline-recommended treatment in a study published in the Journal of the National Comprehensive Cancer Network.

Although the optimal treatment for this population is not well defined, National Comprehensive Cancer Network (NCCN) guidelines recommend treatment with definitive radiotherapy (RT) with or without sequential chemotherapy. 

Lack of Adherence to Treatment Guidelines Evaluated

Researchers evaluated adherence to this recommendation in a retrospective study of 2,020 patients from the National Cancer Database. The patients were diagnosed with non-metastatic, node-negative NSCLC from 2004 to 2016. All had tumor sizes of 5 cm to 7 cm and received definitive RT.

In all, 32.2% of patients received concurrent chemotherapy and RT, which was not in line with NCCN guidelines. The remaining patients received guideline-adherent therapy of either RT alone (50.7%) or RT with sequential chemotherapy (17.1%). 

Types of RT given included conventionally fractionated RT (64.3%), stereotactic body RT (21.8%), and hypofractionated RT (13.9%).

In a multivariable analysis, the odds of receiving nonadherent treatment were significantly higher for the following groups:

  • Patients younger than 70 years (odds ratio [OR], 2.72; P <.001)
  • Patients treated at a nonacademic center (OR, 1.65; P <.001)
  • Patients with tumor sizes of 6-7 cm (OR, 1.27; P =.026).

Insurance type, sex, and year of diagnosis were not associated with nonadherence.

In a univariable analysis, the risk of death was higher among patients who did not receive the guideline-recommended treatment.

However, in a multivariable analysis, overall survival was not affected by guideline adherence (hazard ratio, 1.00; 95% CI, 0.85-1.18; =.992). The median overall survival for the entire cohort was 21 months.

The researchers concluded that “a substantial portion of inoperable patients with large, node-negative NSCLC are not treated according to NCCN guidelines…, but adherence to NCCN guidelines was not associated with differences in overall survival.”


Schneider CS, Oster RA, Hegde A, et al. Nonoperative treatment of large (5–7 cm), node-negative non-small cell lung cancer commonly deviates from NCCN guidelinesJ Natl Compr Canc Netw. Published online August 12, 2021. doi:10.6004/jnccn.2021.7043