Abstract P3-17-05: Physicians’ attitudes and perceived barriers to adherence to national breast cancer clinical practice guidelines (BCCPG) in Mexico

Abstract

Background: Adherence to BCCPG improves clinical outcomes for patients with breast cancer. However, implementation of international BCCPG may not be feasible in low- and middle-income countries (LMICs) due to limitations in resources and personnel. A potential solution for this issue is developing national/regional guidelines considering local healthcare contexts. In Mexico, the National Consensus on Diagnosis and Treatment of Breast Cancer (known as the Colima Consensus, http://consensocancermamario.com) is considered the national BCCPG, and it is updated bi-yearly since 1994. The aim of this study was to evaluate physicians’ uptake of the Colima Consensus recommendations, and to identify barriers and attitudes that may impact adherence. Methods: A cross-sectional, 30-item survey exploring attitudes towards the Colima Consensus, as well as barriers limiting adherence to its recommendations, was e-mailed to Consensus attendees, members of the Mexican Society of Oncology, and of the Mexican Mastology Association, with answers collected over 3 weeks. Descriptive statistics, including means, medians, and standard deviations were used to analyze the participants’ sociodemographic characteristics, attitudes, and perceived barriers. X2 tests were used to evaluate associations between physicians’ characteristics/attitudes and adherence. Results: Among 1553 physicians invited to participate, 320 (21%) answered the survey, of which 25 (8%) were unaware of the Colima Consensus. Two hundred ninety-five participants completed the entire survey and were included in this analysis. Fifty-six percent were male, 65% were age 30-49, 44% practiced in Mexico City, and 8% were foreign. Regarding specialty, 26% were surgical oncologists, 14% medical oncologists, and 10% radiation oncologists. Over half of respondents (57%) worked in both public and private practice, while 19 and 23% worked only in public or private practice, respectively. Sixty-two percent had access to a multidisciplinary breast cancer team. Eighty-five percent reported using the Colima Consensus to guide clinical decision making and 77% adhered to its recommendations in most/all cases. Forty-two percent used the Colima Consensus as their only guideline reference. Surgical oncologists were more likely than medical oncologists to use the Colima Consensus as their only guideline reference (29 vs. 12%, p<0.01). The most commonly reported barriers to adherence were lack of resources (51%) and logistical issues (31%). Physicians working without a dedicated multidisciplinary breast cancer team were significantly more likely to report a lack of resources as a barrier than those with a multidisciplinary team (63 vs. 43%, p<0.01). No differences were found in other barriers according to participants’ characteristics. Regarding attitudes towards the Colima Consensus, 88% agreed/strongly agreed that it was a valuable teaching tool, 88% considered it a trustworthy source of information, and 89% believed it led to improved quality of care. Seventy-six percent of the participants agreed/strongly agreed that the Consensus’ recommendations were free of bias and 58% considered that its use led to reduced costs of care. Conclusions: Initial results of our study show high levels of adherence and positive attitudes towards the Colima Consensus, with a significant proportion of physicians using it as their main guideline reference. Lack of resources and logistical issues were the main barriers hampering implementation of recommendations, particularly for physicians working without a multidisciplinary breast cancer team. Our results highlight the relevance of local BCCPG and of multidisciplinary collaborations, and suggest a need for the creation of stratified recommendations for various healthcare settings and resources. Citation Format: Bertha Alejandra Martinez-Cannon, Enrique Soto-Perez-de-Celis, Aura A. Erazo Valle-Solis, Claudia Arce Salinas, Enrique Bargallo Rocha, Veronica Bautista Piña, Ma. Guadalupe Cervantes Sanchez, Christian Haydee Flores Balcazar, Maria del Carmen Lara Tamburrino, Ana Lluch Hernandez, Antonio Maffuz Aziz, Victor Manuel Perez Sanchez, Adela Poitevin Chacon, Efrain Salas Gonzalez, Laura Torrecillas Torres, Vicente Valero, Yolanda Villaseñor Navarro, Jesus Cardenas Sanchez. Physicians’ attitudes and perceived barriers to adherence to national breast cancer clinical practice guidelines (BCCPG) in Mexico [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-17-05.

Is there still a role for national and regional clinical practice guidelines?

“…In the past, many of these guidelines have been published in the Mexican Journal of Oncology, with some being in the list of the most downloaded manuscripts of our journal 2 . We recently evaluated the adherence to one of those guidelines, the Consenso Mexicano sobre Diagnóstico y Tratamiento del Cáncer Mamario (Mexican Consensus on Diagnosis and Treatment of Breast Cancer) among members of SMeO, with initial results presented at the 2021 San Antonio Breast Cancer Symposium 3 . Interestingly, we found that a large proportion of cancer care providers adhered to the recommendations of the Consensus, and that a significant number, particularly those working at public institutions, used it as their main clinical practice guideline for the treatment of breast cancer.…”

“…Interestingly, we found that a large proportion of cancer care providers adhered to the recommendations of the Consensus, and that a significant number, particularly those working at public institutions, used it as their main clinical practice guideline for the treatment of breast cancer. Interestingly, the main obstacles for its implementation included logistical barriers and the lack of multidisciplinary teams and resources 3 . These results highlight the relevance of creating and publishing 2565-005X/© 2022 Sociedad Mexicana de Oncología.…”