# Impact of Proximity to an Academic Health Center on Adherence to the National Comprehensive Cancer Network (NCCN) Guidelines in Patients With Soft Tissue Sarcomas

## TL;DR

This study found that proximity to a cancer center did not affect adherence to cancer treatment guidelines at an academic institution.

## Contribution

The study provides new insights into how geographic proximity influences adherence to cancer care guidelines.

## Key findings

- All patients met workup compliance according to NCCN guidelines.
- Proximity to the cancer center did not significantly affect adherence to treatment guidelines.
- Socioeconomic and healthcare system barriers may influence non-compliance.

## Abstract

Background

Soft tissue sarcomas (STS) are rare and complex malignancies. Due to their infrequency and complexity, the National Comprehensive Cancer Network (NCCN) provides evidence-based guidelines to guide the workup and treatment of STS. Adherence to these guidelines is crucial, as demonstrated by studies showing improved survival outcomes with compliance. However, factors influencing adherence, such as proximity to treatment centers, remain underexplored. This study aims to assess adherence to the NCCN guidelines at a single academic institution in 2023 and identify factors that affect compliance.

Materials and methods

We performed a retrospective review of patients diagnosed with or treated for STS at a single academic institution in 2023. In accordance with NCCN guidelines and based on tumor staging, we reviewed whether patients received the proper workup and treatment, including a history and physical examination, primary site imaging, core needle biopsy, chest/abdominal imaging, presentation to a multidisciplinary team, wide resection surgery, radiation therapy, and chemotherapy.

Results

A total of 43 patients were included in the study. The most common diagnoses were spindle cell sarcoma and undifferentiated pleomorphic sarcoma, each occurring in 10 patients (22.73% each). The most common TNM stage was IV in 22 patients (51.16%). All 43 patients (100%) met workup compliance according to the NCCN guidelines. Thirty-four patients (79.07%) completed their treatment course, adhering to the NCCN guidelines throughout. Two (4.65%) underwent a complete workup but were seen as second opinions and returned to their previous provider to complete their care. Three (6.98%) were recommended for further treatment of either radiation therapy or chemotherapy but declined. These cases had travel distances of 1.5, 10.9, and 22.5 miles, respectively. Four (9.30%) passed away while undergoing treatment. Travel distance ranged from 1.5 to 201 miles, with a median distance of 31 miles and a median travel time of 55 minutes.

Conclusions

Our findings demonstrate a high rate of compliance with NCCN guidelines at a single academic institution. Contrary to expectations, proximity to the cancer center did not significantly affect adherence. Further studies are needed to explore additional factors influencing non-compliance, such as socioeconomic and healthcare system barriers.