Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Jan 25:13:28.
doi: 10.1186/1472-6963-13-28.

Compliance with clinical practice guidelines for breast cancer treatment: a population-based study of quality-of-care indicators in Italy

Affiliations

Compliance with clinical practice guidelines for breast cancer treatment: a population-based study of quality-of-care indicators in Italy

Carlotta Sacerdote et al. BMC Health Serv Res. .

Abstract

Background: It has been documented that variations exist in breast cancer treatment despite wide dissemination of clinical practice guidelines. The aim of this population-based study was to evaluate the impact of regional guidelines (Piedmont guidelines, PGL) for breast cancer diagnosis and treatment on quality-of-care indicators in the Northwestern Italian region of Piedmont.

Methods: We included two samples of women aged 50-69 years with incident breast cancer treated in Piedmont before and after the introduction of PGL: 600 in 2002 (pre-PGL) and 621 in 2004 (post-PGL). Patients were randomly selected among all incident breast cancer cases identified through the hospital discharge records database. We extracted clinical data on breast cancer cases from medical charts and ascertained vital status through linkage with town offices. We assessed compliance with 14 quality-of-care indicators from PGL recommendations, before and after their introduction in clinical practice.

Results: Among patients with invasive lesions, 77.1% (N = 368) and 77.5% (N = 383) in the pre-PGL and post-PGL groups, respectively, received breast conservative surgery (BCS) as a first-line treatment. Following BCS, 87.7% received radiotherapy in 2002, compared to 87.9% in 2004. Of all patients at medium-to-high risk of distant metastasis, 65.5% (N = 268) and 63.6% (N = 252) received chemotherapy in 2002 and in 2004, respectively. Among the 117 patients with invasive lesions and negative estrogen receptor status in 2002, hormonal therapy was prescribed in 23 of them (19.6%). The incorrect prescription of hormonal therapy decreased to 10.8% (N = 10) among the 92 estrogen receptor-negative patients in 2004 (p < 0.01).Compliance with PGL recommendations was already high in the pre-PGL group, although some quality-of-care indicators did not reach the standard. In the pre/post analysis, 8 out of 14 quality-of-care indicators showed an improvement from 2002 to 2004, but only 4 out of 14 reached statistical significance. We did not find any change in the risk of mortality in the post-PGL versus the pre-PGL group (adjusted hazard ratio 0.94, 95%CI 0.56-1.56).

Conclusions: These results highlight the need to continue to improve breast cancer care and to measure adherence to PGL.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study population of women with incident breast cancer who underwent surgery in 2002 and 2004.
Figure 2
Figure 2
Surgical treatment in women with incident breast cancer who underwent surgery during the first 6 months of 2002 and 2004.
Figure 3
Figure 3
Post-surgical medical treatment in women with incident breast cancer who underwent surgery during the first 6 months of 2002 and 2004.

References

    1. Sainsbury R, Haward B, Rider L, Johnston C, Round C. Influence of clinician workload and patterns of treatment on survival from breast cancer. Lancet. 1995;345(8960):1265–1270. doi: 10.1016/S0140-6736(95)90924-9. - DOI - PubMed
    1. Regione Piemonte Assessorato Sanità, Commissione Oncologica Regionale, Centro di Riferimento per l’Epidemiologia e la Prevenzione Oncologica in Piemonte: Tumore della mammella - linee guida clinico organizzative per la Regione Piemonte. 2002.
    1. Sacerdote C, Pagano E, Ponti A, Rosato R, Senore C, Becattini M, Tomatis M, Piera MM, Vineis P, Ciccone G. The physicians’ view on the utility and impact of oncological guidelines in clinical practice. A survey of Piedmont physicians. Epidemiol Prev. 2007;31(1):34–38. Italian. - PubMed
    1. Malin JL, Schuster MA, Kahn KA, Brook RH. Quality of breast cancer care: what do we know? J Clin Oncol. 2002;20(21):4381–4393. doi: 10.1200/JCO.2002.04.020. - DOI - PubMed
    1. Hillner BE, Smith TJ, Desch CE. Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol. 2000;18(11):2327–2340. - PubMed

Publication types