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. 2020 May;28(5):2175-2184.
doi: 10.1007/s00520-019-05018-2. Epub 2019 Aug 14.

Guideline adherence in bone-targeted treatment of cancer patients with bone metastases in Germany

Hartmut Link  1 , Ingo Diel  2 , Carsten-H Ohlmann  3 , Laura Holtmann  4 , Markus Kerkmann  4 ; Associations Supportive Care in Oncology (AGSMO), Medical Oncology (AIO), Urological Oncology (AUO), within the German Cancer Society (DKG) and the German Osteooncological Society (DOG)
Affiliations

Guideline adherence in bone-targeted treatment of cancer patients with bone metastases in Germany

Hartmut Link et al. Support Care Cancer. 2020 May.

Abstract

Purpose: To assess adherence to the current European Society for Medical Oncology (ESMO) clinical practice guideline on bone health in cancer patients and the German guidelines for lung, breast, and prostate cancer among German oncologists in hospitals and office-based physicians and to identify predictors of guideline compliance to assess the needs for dedicated training.

Methods: This was a retrospective sample analysis representing hospitals and office-based physicians in Germany in 2016. Records from lung, breast, and prostate cancer patients who had received a diagnosis of bone metastasis between April 1, 2015, and March 31, 2016, were included. Oncologists at participating centers answered a self-assessment survey on aspects related to their professional life, including guideline adherence and years of clinical experience in medical oncology. Guideline adherence rates were assessed from patient records. Treatment variables and survey data were used to identify predictors of guideline compliance in a Classification and Regression Tree (CART) analysis.

Results: Disregarding recommendations for supplementation of calcium and vitamin D, guideline adherence among physicians treating lung, breast, or prostate cancer patients was 62%, 92%, and 83%, respectively. Compliance was 15%, 42%, and 40% if recommendations for dietary supplements were taken into account. Identified predictors of guideline compliance included treatment setting, medical specialty, years of professional experience, and frequency of quality circle attendance.

Conclusions: Compliance with the ESMO and the German guidelines in cancer patients varies between medical specialties. In particular, patients with lung cancer and bone metastases often do not receive the recommended osteoprotective treatment and required supplementation. Discrepancies between guideline recommendations and common practice should be addressed with dedicated training.

Keywords: Bisphosphonate; Bone metastases; Denosumab; Guideline adherence; Osteolysis; Osteoprotection; RANK ligand inhibition.

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Conflict of interest statement

Professor Link received research funding and honoraria, acted on speakers’ bureau, and/or consulted for Accord Healthcare, Amgen, Hexal-Sandoz-Novartis and TEVA Mr Kerkmann and Mrs Holtmann report payment from AIO-Studien-gGmbH, during the conduct of the study. Dr. Ohlmann reports personal fees from AMGEN, during the conduct of the study. Dr. Diel reports personal fees from Amgen, personal fees from Roche, personal fees from Hexal, outside the submitted work.

Figures

Fig. 1
Fig. 1
Guideline adherence in bone-targeted therapy (“weak standard”)
Fig. 2
Fig. 2
Guideline adherence in bone-targeted therapy (“strict standard”)
See this image and copyright information in PMC

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