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Multifaceted Program Improves Guideline Adherence in Younger Patients With ALL

September 27, 2018

Researchers from a large health care system implemented a multifaceted program that improved the uptake of National Comprehensive Cancer Network (NCCN) guideline recommendations for adolescent and young adults with acute lymphoblastic leukemia (ALL) by 54%.

ALL is a common malignancy in adolescent and young adults and is linked with poor survival in this population compared with children. While NCCN guidelines now recommend consideration of pediatric regimens for the treatment of adolescent and young adults, uptake has been suboptimal. Barriers to uptake include lack of knowledge and guidance about these recommendations.

Erin Elizabeth Hahn, PhD, MPH, Kaiser Permanente Southern California, and colleagues implemented a multifaceted program to improve uptake of these guidelines in adolescents and young adults with ALL. The program was initiated in 14 medical centers in the Kaiser Permanente Southern California health care system in 2013. Included in the program was education of clinical leaders, rapid identification of newly diagnosed adolescents and young adults with ALL by the hematopathology team, as well as guidance and support from a pediatric oncologist for adult oncology teams that emphasized a pediatric regimen when appropriate.

Results of the program will be presented at the American Society of Clinical Oncology (ASCO) Quality Care Symposium (September 28-29, 2018; Phoenix, AZ).

Researchers identified 58 adolescent and young adult patients with ALL who were diagnosed and treated between 2012 and 2016. Eleven of the patients were identified in the period prior to implementation of the program and the remaining 47 patients were identified post-implementation.

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Dr Hahn and colleagues reported that 18% of patients in the pre-implementation period were treated on a pediatric regimen compared with 77% of patients in the post-implementation period. Additionally, they observed an increasing trend over time in the post-implementation period, with 46% of patients receiving a pediatric protocol in 2013, 64% in 2014, 92% in 2015, and 100% in 2016.

“Implementing a multi-faceted approach to improve care for this rare condition was feasible and acceptable to oncology clinicians across the region, with potential for large-scale scale-up and spread,” authors of the study concluded.—Zachary Bessette

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