eP165 - Adherence to NCCN Anal Squamous Cell Carcinoma Surveillance Guidelines Is Low and Not Associated with Recurrence

ePoster Presenter(s)

• 

  Jeffrey L. Roberson, MD

  Resident
  The Hospital of the University of Pennsylvania
  The Hospital of the University of Pennsylvania
  Philadelphia, PA, United States

  Disclosure information not submitted.

Author(s)

• AK

  Alyson H. Kim, BA

  Medical Student
  Drexel University College of Medicine
  Philadelphia, Pennsylvania, United States

  Disclosure information not submitted.
• 

  Christopher J. Neylan, MD

  General Surgery Resident
  Hospital of the University of Pennsylvania
  Hospital of the University of Pennsylvania
  Philadelphia, PA, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• 

  Kerri Lopez, MD (she/her/hers)

  Colon & Rectal Surgery Fellow
  University of Pennsylvania
  University of Pennsylvania
  Philadelphia, PA, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• PH

  Paul Hernandez, MD

  Assistant Professor
  University of Pennsylvania, Division of Colon and Rectal Surgery
  Philadelphia, PA, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.
• EP

  Erica Pettke, MD, MPH, FACS

  Assistant Professor of Surgery
  University of Pennsylvania
  philadelphia, Pennsylvania, United States

  Disclosure information not submitted.
• 

  Nicole M. Saur, MD, FACS, FASCRS (she/her/hers)

  Associate Professor of Clinical Surgery
  University of Pennsylvania
  University of Pennsylvania
  Philadelphia, PA, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no relevant relationships with ineligible companies.
• 

  Joshua I. S Bleier, MD (he/him/his)

  Chair of Surgery, Pennsylvania Hospital; Program Director Colorectal Fellowship
  University of Pennsylvania
  University of Pennsylvania
  Bala Cynwyd, PA, United States

  Disclosure information not submitted.
• 

  Najjia N. Mahmoud, MD

  Physician
  University of Pennsylvania Health System
  University of Pennsylvania
  Philadelphia, Pennsylvania, United States

  All relevant financial disclosures have been managed and will be listed below.
  This individual has no financial relationships with ineligible companies.

Senior Author(s)

• LM

  Lillias Maguire, MD FACS

  Assistant Professor of Surgery
  University of Pennsylvania
  Philadelphia, Pennsylvania, United States

  Disclosure information not submitted.

Purpose/Background: Following complete response to chemotherapy and radiation (chemoRT), surveillance of anal squamous cell carcinoma (ASCC) follows National Comprehensive Cancer Network (NCCN) guidelines including digital rectal exam (DRE), inguinal node palpation, anoscopy, and cross-sectional imaging at frequent intervals. Surveillance may be performed by colorectal surgeons, oncologists, or both and there is a knowledge gap regarding patient-provider adherence with guidelines. In this retrospective study we review the ASCC surveillance adherence, burden, and pattern at a large volume academic institution.Methods/Interventions: A retrospective review of the PennMedicine Cancer Registry was conducted from January 1, 1983 to December 31, 2018. Patients were included for review if their primary site of malignancy was “anus and anal canal,” they received chemoRT at an affiliated hospital, and they had ongoing care at PennMedicine for 5 years after. Exclusion criteria included death within 5 years, lack of a complete response to chemoRT, and loss to follow up. Our practice pattern includes both visits with colorectal surgeons (CRS) and medical oncologist for physical exams and imaging, respectively. Patients were classified as under-users, maximizers, and over-users based on adherence with 2018 NCCN Guidelines. Recurrence rates were compared using Chi-squared testing.Results/Outcomes: 137 patients completed chemoradiation; 86 of which had 5 years of follow-up data and a complete response to treatment. Of those 86, only 5 (5.8%) were compliant with NCCN surveillance guidelines. The vast majority (76 [88%]) were under-users of CRS surveillance. 10 (12%) were maximizers and none were over-users. CRS under-users were split between under (36 [47%]) and over (26 [34%]) use of medical oncology. Among the 10 CRS maximizers, 8 were medical oncology maximizers or over-users (Figure 1). Over the 5 years, 12 patients (13.9%) recurred. There was no difference in recurrence rate between groups (p=0.933) (Figure 1).Conclusion/

Discussion: Adherence with surveillance guidelines was very low, largely due to under-use of colorectal surgery surveillance. This could reflect barriers to care, underappreciation of the role of surgeons in surveillance, or avoidance of invasive physical exams. CRS maximizers tended to be highly compliant with medical oncology-based surveillance as well while CRS under-users either had low adherence overall or supplemented their surveillance with overuse of medical oncology, suggesting two distinct groups and opportunities for improvement. While our institutional findings may not be generalizable, we suggest other institutions and groups many find review of their ASCC surveillance patterns important and informative.Adherence with Anal Squamous Cell Carcinoma NCCN Surveillance Guidelines and Subsequent Disease RecurrenceOverall, adherence with NCCN anal squamous cell carcinoma surveillance guidelines is low and not associated with recurrence.