[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-detail-339837-en":59,"doc-seo-339837-105":80},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":5,"data":60},{"doc_id":61,"user_id":62,"nickname":63,"user_avatar":64,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":66,"doc_content":67,"file_id":68,"file_url":69,"file_type":70,"file_size":71,"view_count":24,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":72,"language_code":73,"site_id":74,"html_lang":73,"table_of_contents":75,"faqs":76,"seo_title":77,"seo_description":66,"update_tm":78,"read_time":79},339837,1099514068035,"Ezra","https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Understanding Barriers to Guideline‑Concordant Treatment in Foregut Cancer: From Data to Solutions","Examining foregut cancers (gastric, pancreatic, and hepatobiliary), this study addresses the substantial gap in receiving guideline-concordant treatment (GCT). A single-institution retrospective review of 498 patients from 2018–2022 used root cause analysis with the Ishikawa cause-and-effect model to explain why 34% did not receive GCT. Non-GCT roots spanned patient, physician, institutional environment, and broader system factors, including incomplete therapy, chemotherapy deconditioning, care delays, loss to follow-up, and missing referrals or documentation. Proposed solutions focus on automated follow-up systems, resource prioritization, financial support, and structured prehabilitation integration.","Ann Surg Oncol (2024) 31:6007–6016  \n[https://doi.org/10.1245/s10434-024-15627-9](https://doi.org/10.1245/s10434-024-15627-9)  \nORIGINAL ARTICLE – GASTROINTESTINAL ONCOLOGY  \nUnderstanding Barriers to Guideline‑Concordant Treatment in Foregut Cancer: From Data to Solutions  \nAnnabelle L. Fonseca, MD, MHS, FACS1,2, Rida Ahmad, MD3, Krisha Amin, BS3,  \nManish Tripathi, BE, MBA4, Ahmed Abdalla, MD3, Larry Hearld, PhD5, Smita Bhatia, MD, MPH2, and  \nMartin J. Heslin, MD, MSHA, FACS3  \n1Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL; 2Institute for Cancer Outcomesand Survivorship, The University of Alabama at Birmingham, Birmingham, AL; 3Department of Surgery, The University of South Alabama, Mobile, AL; 4Kellogg School of Management, Northwestern University, Chicago, IL; 5Department of Health Services Administration, The University of Alabama at Birmingham, Birmingham, AL  \nABSTRACT  \nBackground. A large proportion of patients with foregut cancers do not receive guideline-concordant treatment (GCT). This study sought to understand underlying barriers to GCT through a root cause analysis approach.  \nMethods. A single-institution retrospective review of 498 patients with foregut (gastric, pancreatic, and hepatobiliary) adenocarcinoma from 2018 to 2022 was performed. Guideline-concordant treatment was defined based on National Comprehensive Cancer Network guidelines. The Ishikawa cause and effect model was used to establish main contributing factors to non-GCT.  \nResults. Overall, 34% did not receive GCT. Root causes of non-GCT included Patient, Physician, Institutional Environment and Broader System-related factors. In decreasing order of frequency, the following contributed to non-GCT: receipt of incomplete therapy (N = 28, 16.5%), deconditioning on chemotherapy (N = 26, 15.3%), delays in care because of patient resource constraints followed by loss to follow-up (N = 19, 11.2%), physician factors (N = 19, 11.2%), no documentation of treatment plan after referral to oncologic expertise (N = 19, 11.2%), loss to follow-up before oncology referral (N = 17, 10%), nonreferral to medical oncologic expertise (N = 16, 9.4%), nonreferral to surgical oncology in patients with resectable disease (N = 15,  \n© The Author(s) 2024  \nFirst Received: 23 April 2024  \nAccepted: 4 June 2024  \nPublished online: 2 July 2024  \nA. L. Fonseca, MD, MHS, FACSe-mail: [afonseca@uabmc.edu](afonseca@uabmc.edu)  \n8.8%), and complications preventing completion of treatment (N = 11, 6 .5%) . Non-GCT often was a function of multiple intersecting patient, physician, and institutional factors. Conclusions. A substantial percentage of patients with foregut cancer do not receive GCT. Solutions that may improve receipt of GCT include development of automated systems to improve patient follow-up; institutional prioritization of resources to enhance staffing; financial counseling and assistance programs; and development and integration of structured prehabilitation programs into cancer treatment pathways.  \nAbdominal foregut cancers, i.e., cancers of the stomach, pancreas, liver, and biliary system, account for more than 20% of new cancer deaths in the United States each year.1 These cancers are associated with poor overall survival due to both tumor-related factors, including inherent biological aggressiveness and relative chemoresistance, as well as challenges to the delivery of care. Guideline-concordant treatment (GCT), i.e., stage-specific, standard of care treatment has been shown to improve patient outcomes in foregut cancers; however, institutional and national studies report that up to 70% of patients with foregut cancers do not receive GCT.2–8  \nA large percentage of patients with foregut cancer present with metastatic disease, where systemic therapy is the mainstay of treatment. In patients with anatomicallyresectable, nonmetastatic cancer, multimodal therapy with curative-intent surgical resection and chemotherapy is generally rec","cbCail2ps6WN0nsN","https://ap.wps.com/l/cbCail2ps6WN0nsN","pdf",544713,"English","en",105,"# Abstract\n## Background\n## Methods\n## Results\n## Conclusions\n# Introduction\n# Methods\n## Study Population\n## Data Collection","[{\"question\":\"What is the main objective of the study on foregut cancer treatment?\",\"answer\":\"To identify underlying barriers that prevent patients with foregut cancers from receiving guideline-concordant treatment (GCT) using a root cause analysis approach.\"},{\"question\":\"How was guideline-concordant treatment (GCT) defined in this research?\",\"answer\":\"GCT was defined according to National Comprehensive Cancer Network guidelines as stage-specific standard-of-care treatment.\"},{\"question\":\"Which factor categories were identified as root causes of not receiving GCT?\",\"answer\":\"Root causes included patient-related factors, physician-related factors, institutional environment factors, and broader system-related factors.\"}]","Understanding Barriers to Guideline‑Concordant Treatment in Foregut Cancer: From Data to Solutions | PDF",1790032546,25,{"code":4,"msg":81,"data":82},"ok",{"site_id":74,"language":73,"slug":83,"title":65,"keywords":84,"description":66,"schema_data":85,"social_meta":139,"head_meta":141,"extra_data":143,"updated_unix":144},"understanding-barriers-to-guidelineconcordant-treatment-in-foregut-cancer-from-data-to-solutions","",{"@graph":86,"@context":138},[87,101,121],{"@type":88,"itemListElement":89},"BreadcrumbList",[90,94,96,99],{"item":91,"name":92,"@type":93,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":95,"name":9,"@type":93,"position":14},"https://docshare.wps.com/document/",{"item":97,"name":35,"@type":93,"position":98},"https://docshare.wps.com/document/healthcare/",3,{"item":100,"name":65,"@type":93,"position":19},"https://docshare.wps.com/document/understanding-barriers-to-guidelineconcordant-treatment-in-foregut-cancer-from-data-to-solutions/339837/",{"url":100,"name":65,"@type":102,"image":103,"author":108,"headline":65,"publisher":110,"fileFormat":113,"inLanguage":73,"description":66,"dateModified":114,"datePublished":115,"encodingFormat":113,"isAccessibleForFree":116,"interactionStatistic":117},"DigitalDocument",{"url":104,"@type":105,"width":106,"height":107},"https://docshare.wps.com/thumbnails/understanding-barriers-to-guidelineconcordant-treatment-in-foregut-cancer-from-data-to-solutions/339837.png","ImageObject",300,407,{"name":63,"@type":109},"Person",{"url":91,"name":111,"@type":112},"DocShare","Organization","application/pdf","2026-10-30","2026-09-21",true,{"@type":118,"interactionType":119,"userInteractionCount":24},"InteractionCounter",{"@type":120},"ViewAction",{"@type":122,"mainEntity":123},"FAQPage",[124,130,134],{"name":125,"@type":126,"acceptedAnswer":127},"What is the main objective of the study on foregut cancer treatment?","Question",{"text":128,"@type":129},"To identify underlying barriers that prevent patients with foregut cancers from receiving guideline-concordant treatment (GCT) using a root cause analysis approach.","Answer",{"name":131,"@type":126,"acceptedAnswer":132},"How was guideline-concordant treatment (GCT) defined in this research?",{"text":133,"@type":129},"GCT was defined according to National Comprehensive Cancer Network guidelines as stage-specific standard-of-care treatment.",{"name":135,"@type":126,"acceptedAnswer":136},"Which factor categories were identified as root causes of not receiving GCT?",{"text":137,"@type":129},"Root causes included patient-related factors, physician-related factors, institutional environment factors, and broader system-related factors.","https://schema.org",{"og:url":100,"og:type":140,"og:title":65,"og:site_name":111,"og:description":66},"article",{"robots":142,"canonical":100},"index,follow",{"doc_id":61,"site_id":74},1790894246]