Evaluation of guideline-concordant treatment and clinical outcomes in non-small cell lung cancer: A study at a National-Referral Hospital in Indonesia

Non-adherence to guidelines has been demonstrated to affect clinical outcomes. With more than half of the global incidence of lung cancer occurring in Asia, this study aims to evaluate the guideline-concordant treatment (GCT) among Asian patients based on the 2018 NCCN-Asia consensus statements on NSCLC. Patients diagnosed with NSCLC between December 2018 and 2019 were identified from electronic medical records. Patients with complete data were divided into GCT-positive and negative groups. Statistical analyses were performed to analyze survival distributions and the associations between covariates and GCT status. Out of 50 patients, 90% were in stage IV. No patients underwent PET scans nor stereotactic radiotherapy due to the absence of facilities. Overall, 44% of patients were GCT-positive. Most GCT-negative patients did not receive chemotherapy due to poor performance scores. There was a significant difference in the survival distribution between groups (72.7% vs 39.3%, p=0.006). Age and sex were not significantly associated with GCT status (p>0.05). After accounting for other covariates including histology, GCT-negative was still associated with an increased hazard of all-cause mortality (HR 3.07 [1.15-8.12]; p=0.025). Despite limitations, concordance with Asian-specific guidelines independently and significantly improved OS among patients at a national-referral hospital in Indonesia.