Compliance with guidelines is related to better local recurrence-free survival in ductal carcinoma in situ

Abstract

The aim was to study the effect of compliance with guidelines on local recurrence (LR)-free survival in patients treated for ductal carcinoma in situ (DCIS). From January 1992 to December 2003, 251 consecutive patients had been treated for DCIS in two hospitals in the North Netherlands. Every case in this two-hospital sample was reviewed in retrospect for its clinical and pathological parameters. It was determined whether treatment had been carried out according to clinical guidelines, and outcomes in follow-up were assessed. In addition, all patients treated for DCIS in this region (n ¼ 1389) were studied regarding clinical parameters, in order to determine whether the two-hospital sample was representative of the entire region. In the two-hospital sample, 31.4% (n ¼ 79) of the patients had not been treated according to the guidelines. Positive margins were associated with LR (hazard ratio (HR) ¼ 4.790, 95% confidence interval (CI) 1.696 -13.531). Breast-conserving surgery and deviation from the guidelines were independent predictors of LR (HR ¼ 7.842, 95% CI 2.126 -28.926; HR ¼ 2.778, 95% CI 0.982 -6.781, respectively). Although the guidelines changed over time, time was not a significant factor in predicting LRs (HR ¼ 1.254, 95% CI 0.272 -5.776 for time period 1992 -1995 and HR ¼ 1.976, 95% CI 0.526 -7.421 for time period 1996. Clinical guidelines for the treatment of patients with DCIS have been developed and updated from existing literature and best evidence. Compliance with the guidelines was an independent predictor of disease-free survival. These findings support the application of guidelines in the treatment of DCIS.

Adherence to breast cancer guidelines is associated with better survival outcomes: a systematic review and meta-analysis of observational studies in EU countries

“…The random effects meta-analysis of three studies followed up a median of 5 years with 9224 patients [20,36,49] (Fig. 3, Table 3) showed better disease-free survival rates in patients receiving CG recommended treatment compared to those not receiving CG recommended treatment (HR = 0.35 (95% CI from 0.15 to 0.82); I 2 = 96%).…”

Healthcare providers’ adherence to breast cancer guidelines in Europe: a systematic literature review

“…Still, they reported findings for two different subpopulations. Similarly, eleven retrospective studies used data from the National Cancer Registry of the Netherlands but analysed different regions or periods [40][41][42][43][44][45][46][47][48][49][50].…”

Hospital differences in patient satisfaction with care for breast, colorectal, lung and prostate cancers

“…Variations in clinical outcomes can be affected by health service organisational characteristics. Hospital factors that may affect survival in cancer care include volume (overview [8], and for breast and prostate cancer surgery [9,10]); specialisation, (eg colorectal and ovarian cancers [11,12]); treatment standards (eg colorectaland breast cancers [13,14]; staffing levels [15] and academic (teaching or specialist) hospital status [16,17]. But there is less evidence for organisational factors relating to satisfaction.…”