Canadian breast cancer guidelines: Have they made a difference?

Latosinsky, Steven; Fradette, Katherine; Lix, Lisa M.; Hildebrand, Karen; Turner, Donna

doi:10.1503/cmaj.060854

Cited by 43 publications

(32 citation statements)

References 11 publications

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“…There are limits to what can be ascertained using administrative data. The mcr is a highly accurate source of information about breast cancer 13 ; however, errors in coding can result in incorrect or unrecorded procedures. In the present analysis, we were careful to prevent incorrect ascertainment of breast cancer treatments (including surgery, radiation therapy, endocrine therapy, and chemotherapy) by examining all treatments from two sources-that is, the mcr and the Manitoba administrative databases held by Manitoba Health.…”

Section: Discussionmentioning

confidence: 99%

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Evaluating the Efficacy of Current Clinical Practice of Adjuvant Chemotherapy in Postmenopausal Women with Early-Stage, Estrogen or Progesterone Receptor–Positive, One-To-Three Positive Axillary Lymph Node, Breast Cancer

et al. 2012

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Section: Discussionmentioning

confidence: 99%

“…The mcr is a provincial database that contains records for more than 99.5% of all cases of cancer in Manitoba 13 . Information on breast-cancer staging, based on the American Joint Committee on Cancer version 5 standard, has been routinely collected for breast cancers diagnosed since January 1995 14 .…”

Section: Data Sourcementioning

confidence: 99%

Evaluating the Efficacy of Current Clinical Practice of Adjuvant Chemotherapy in Postmenopausal Women with Early-Stage, Estrogen or Progesterone Receptor–Positive, One-To-Three Positive Axillary Lymph Node, Breast Cancer

et al. 2012

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“…The mcr is a provincial database that contains records for more than 99.5% of all cancer cases in Manitoba 17 . Information on cancer staging, based on the American Joint Committee on Cancer staging system (version 5), has been routinely collected for all cancer sites since January 1995 18 .…”

Section: Study Design and Data Sourcesmentioning

confidence: 99%

The Clinical Significance of Occult Gynecologic Primary Tumours in Metastatic Cancer

et al. 2017

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Objective We estimated the frequency of occult gynecologic primary tumours (gpts) in patients with metastatic cancer from an uncertain primary and evaluated the effect on disease management and overall survival (os). MethodsWe used Manitoba administrative health databases to identify all patients initially diagnosed with metastatic cancer during 2002−2011. We defined patients as having an "occult" primary tumour if the primary was classified at least 6 months after the initial diagnosis. Otherwise, we considered patients to have "obvious" primaries. We then compared clinicopathologic and treatment characteristics and 2-year os for women with occult and with obvious gpts. We used Cox regression adjustment and propensity score methods to assess the effect on os of having an occult gpt.Results Among the 5953 patients diagnosed with metastatic cancer, occult primary tumours were more common in women (n = 285 of 2552, 11.2%) than in men (n = 244 of 3401, 7.2%). In women, gpts were the most frequent occult primary tumours (n = 55 of 285, 19.3%). Compared with their counterparts having obvious gpts, women with occult gpts (n = 55) presented with similar histologic and metastatic patterns but received fewer gynecologic diagnostic examinations during diagnostic work-up. Women with occult gpts were less likely to undergo surgery, waited longer for radiotherapy, and received a lesser variety of chemotherapeutic agents. Having an occult compared with an obvious gpt was associated with decreased os (hazard ratio: 1.62; 95% confidence interval: 1.2 to 2.35). Similar results were observed in adjusted analyses. ConclusionsIn women with metastatic cancer from an uncertain primary, gpts constitute the largest clinical entity.Accurate diagnosis of occult gpts early in the course of metastatic cancer might lead to more effective treatment decisions and improved survival outcomes.

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“…Although there is evidence that guidelines can improve clinical outcomes [12][13][14] there are grounds for concern that the potential created by the enormous effort that goes into creating them may not be matched by the level of adherence to them in practice. [15][16][17][18] Chidgey et al acknowledge this in the context of the NICE programme and Chalmers observes that 'the available evidence suggests that there is plenty of room for improvement in the difficult area of changing clinical practice'. We now review a number of obstacles to changing clinicians' behavior by means of CPGs, before turning to a discussion of how decision support can help to mitigate these difficulties.…”

Section: Practice Guidelines and Decision Supportmentioning

confidence: 99%