很大一部分前肠癌患者没有接受符合指南的治疗（GCT）。本研究试图通过根本原因分析方法了解 GCT 的潜在障碍。对 2018 年至 2022 年 498 名前肠（胃、胰腺和肝胆）腺癌患者进行了单机构回顾性评价。符合指南的治疗是根据国家综合癌症网络指南定义的。 Ishikawa 因果模型用于确定非 GCT 的主要影响因素。总体而言，34% 的人未接受 GCT。非 GCT 的根本原因包括患者、医生、机构环境和更广泛的系统相关因素。按频率降序排列，以下因素导致非 GCT：接受不完整治疗 (N = 28, 16.5%)、化疗后身体状况不佳 (N = 26, 15.3%)、由于患者资源有限而导致护理延误以及随后的死亡未能进行随访 (N = 19, 11.2%)、医生因素 (N = 19, 11.2%)、转诊肿瘤专家后没有治疗计划记录 (N = 19, 11.2%)、肿瘤学前失访转诊（N = 17， 10%），未转诊至肿瘤内科专业知识（N = 16， 9.4%），患有可切除疾病的患者未转诊至肿瘤外科（N = 15， 8.8%），以及妨碍完成治疗的并发症（N = 11, 6.5%）。非 GCT 通常是患者、医生和机构等多重交叉因素的作用。相当大比例的前肠癌患者没有接受 GCT。可以改善 GCT 接受情况的解决方案包括开发自动化系统以改善患者随访；确定资源的机构优先顺序，以加强人员配置；财务咨询和援助计划；结构化预康复计划的开发和整合到癌症治疗途径中。© 2024。作者。

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.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.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, 8.8%), and complications preventing completion of treatment (N = 11, 6.5%). Non-GCT often was a function of multiple intersecting patient, physician, and institutional factors.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.© 2024. The Author(s).