Guidelines are advantageous, though not essential for improved survival among breast cancer patients

Wolters, Regine; Wischhusen, Jörg; Stüber, Tanja; Weiß, Claire; Krockberger, Mathias; Bartmann, Catharina; Blettner, Maria; Janni, Wolfgang; Schwentner, Lukas; Novopashenny, I.; Wischnewsky, Manfred; Wöckel, Achim; Diessner, Joachim

doi:10.1007/s10549-015-3484-2

Cited by 12 publications

(11 citation statements)

References 18 publications

(29 reference statements)

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“…25 The adherence to the corresponding guide line, specifically to the recommendations on adjuvant endocrine therapy, is high and above 80%. 26 Because aromatase inhibitor treatment is recommended in postmenopausal patients and in lobular breast cancer patients 25 who provide the majority of ESR1-mutated cases in this study, most of the mutated cases have probably been treated with an aromatase inhibitorcontaining regimen.…”

Section: Endocrine Pretreatment Of Metastatic Breast Cancer With Esr1mentioning

confidence: 99%

Estrogen receptor (ESR1) mutation in bone metastases from breast cancer

et al. 2018

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Activating mutations of estrogen receptor α gene (ESR1) in breast cancer can cause endocrine resistance of metastatic tumor cells. The skeleton belongs to the metastatic sides frequently affected by breast cancer. The prevalence of ESR1 mutation in bone metastasis and the corresponding phenotype are not known. In this study bone metastases from breast cancer (n=231) were analyzed for ESR1 mutation. In 27 patients (12%) (median age 73 years, range: 55-82 years) activating mutations of ESR1 were detected. The most frequent mutation was p.D538G (53%), no mutations in exon 4 (K303) or 7 (S463) were found. Lobular breast cancer was present in 52% of mutated cases (n=14) and in 49% of all samples (n=231), respectively. Mutated cancers constantly displayed strong estrogen receptor expression. Progesterone receptor was positive in 78% of the mutated cases (n=21). From 194 estrogen receptor-positive samples, 14% had ESR1 mutated. Except for one mutated case, no concurrent HER2 overexpression was noted. Metastatic breast cancer with activating mutations of ESR1 had a higher Ki67 labeling index than primary luminal cancers (median 30%, ranging from 5 to 60% with 85% of cases revealing ≥20% Ki67-positive cells). From those patients from whom information on endocrine therapy was available (n=7), two had received tamoxifen only, 4 tamoxifen followed by aromatase inhibitors and one patient had been treated with aromatase inhibitors only. We conclude that ESR1 mutation is associated with estrogen receptor expression and high proliferative activity and affects about 14% of estrogen receptor-positive bone metastases from breast cancer.

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Section: Endocrine Pretreatment Of Metastatic Breast Cancer With Esr1mentioning

confidence: 99%

Estrogen receptor (ESR1) mutation in bone metastases from breast cancer

et al. 2018

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“…Their characteristics and main results are available in Additional files 4 and 5. A direct association between adherence to breast cancer CGs and better overall survival was more frequently observed regardless of the study period [22], the use of different cut-offs or number of deviations to CGs recommendations used to determine adherence [17,42,48] and patient's age [17,18,37,41,44,45]. Although non-adherence was associated with lower survival rate both in triple negative breast cancer (TNBC) and non-TNBC patients, this association was stronger in TNBC than in non-TBNC patients [19,43].…”

Section: Impact On Patient Outcomes Overall Survivalmentioning

confidence: 99%

“…Additionally, this outcome was reported in another 15 studies not meeting the criteria for performing a metaanalysis as specified in the methods section. An association between adherence to breast cancer CGs and better disease-free survival was observed consistently regardless of the study period [22,47], use of different [18,19,38,45] High 0 (0%) - ‡ Percentages exceed 100% because the categories are not mutually exclusive (i.e. some studies involved more than one type of guideline and more than one type of outcome) cut-offs to determine adherence [43,47,48], patient's age [18,41] and subtype of tumour [42,43].…”

Section: Disease-free Survivalmentioning

confidence: 99%

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

Ricci‐Cabello

Vásquez-Mejía

Canelo‐Aybar

et al. 2020

BMC Health Serv Res

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Background Breast cancer (BC) clinical guidelines offer evidence-based recommendations to improve quality of healthcare for patients with or at risk of BC. Suboptimal adherence to recommendations has the potential to negatively affect population health. However, no study has systematically reviewed the impact of BC guideline adherence -as prognosis factor- on BC healthcare processes and health outcomes. The objectives are to analyse the impact of guideline adherence on health outcomes and on healthcare costs. Methods We searched systematic reviews and primary studies in MEDLINE and Embase, conducted in European Union (EU) countries (inception to May 2019). Eligibility assessment, data extraction, and risk of bias assessment were conducted by one author and crosschecked by a second. We used random-effects meta-analyses to examine the impact of guideline adherence on overall survival and disease-free survival, and assessed certainty of evidence using GRADE. Results We included 21 primary studies. Most were published during the last decade (90%), followed a retrospective cohort design (86%), focused on treatment guideline adherence (95%), and were at low (80%) or moderate (20%) risk of bias. Nineteen studies (95%) examined the impact of guideline adherence on health outcomes, while two (10%) on healthcare cost. Adherence to guidelines was associated with increased overall survival (HR = 0.67, 95%CI 0.59–0.76) and disease-free survival (HR = 0.35, 95%CI 0.15–0.82), representing 138 more survivors (96 more to 178 more) and 336 patients free of recurrence (73 more to 491 more) for every 1000 women receiving adherent CG treatment compared to those receiving non-adherent treatment at 5 years follow-up (moderate certainty). Adherence to treatment guidelines was associated with higher costs, but adherence to follow-up guidelines was associated with lower costs (low certainty). Conclusions Our review of EU studies suggests that there is moderate certainty that adherence to BC guidelines is associated with an improved survival. BC guidelines should be rigorously implemented in the clinical setting. Trial registration PROSPERO (CRD42018092884).

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“…We finally included 57 references representing 41 primary studies. Three studies were reported in more than one publication: BRENDA I [12,13,[20][21][22][23][24][25][26][27][28], BRENDA II [29][30][31], and OncoDoc2 [32][33][34]. (Fig.…”

Section: Study Selectionmentioning

confidence: 99%

“…Six studies addressed the overall treatment process (surgery, CT, ET, and RT). These studies represented patients receiving treatment in the period from 1991 to 2009 [28,32,41,48,59,63]. The median adherence was 57.5% (IQR 38.8-67.3%), and ranged from 29 [63] to 91% [32].…”

Section: Overall Treatment Processmentioning

confidence: 99%

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

Guzmán

Song

Alonso‐Coello

et al. 2020

Breast Cancer Res Treat

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Purpose Clinical guidelines' (CGs) adherence supports high-quality care. However, healthcare providers do not always comply with CGs recommendations. This systematic literature review aims to assess the extent of healthcare providers' adherence to breast cancer CGs in Europe and to identify the factors that impact on healthcare providers' adherence. Methods We searched for systematic reviews and quantitative or qualitative primary studies in MEDLINE and Embase up to May 2019. The eligibility assessment, data extraction, and risk of bias assessment were conducted by one author and cross-checked by a second author. We conducted a narrative synthesis attending to the modality of the healthcare process, methods to measure adherence, the scope of the CGs, and population characteristics. Results Out of 8137 references, we included 41 primary studies conducted in eight European countries. Most followed a retrospective cohort design (19/41; 46%) and were at low or moderate risk of bias. Adherence for overall breast cancer care process (from diagnosis to follow-up) ranged from 54 to 69%; for overall treatment process [including surgery, chemotherapy (CT), endocrine therapy (ET), and radiotherapy (RT)] the median adherence was 57.5% (interquartile range (IQR) 38.8-67.3%), while for systemic therapy (CT and ET) it was 76% (IQR 68-77%). The median adherence for the processes assessed individually was higher, ranging from 74% (IQR 10-80%), for the follow-up, to 90% (IQR 87-92.5%) for ET. Internal factors that potentially impact on healthcare providers' adherence were their perceptions, preferences, lack of knowledge, or intentional decisions. Conclusions A substantial proportion of breast cancer patients are not receiving CGs-recommended care. Healthcare providers' adherence to breast cancer CGs in Europe has room for improvement in almost all care processes. CGs development and implementation processes should address the main factors that influence healthcare providers' adherence, especially patient-related ones. Registration: PROSPERO (CRD42018092884). Keywords Breast neoplasms • Guidelines as topic • Evidence-based medicine • Guideline adherence • Systematic review Abbreviations CGs Clinical guidelines RT Radiotherapy CT Chemotherapy ET Endocrine therapy or hormonal therapy BCS Breast-conserving surgery MT Mastectomy ALND Axillary lymph node dissection TNBC Triple-negative breast cancer SLNB Sentinel lymph node biopsy HER2 Human epidermal growth receptor 2 Ena Niño de Guzmán and Yang Song have contributed equally to work and should be regarded as co-first authors.

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Guidelines are advantageous, though not essential for improved survival among breast cancer patients

Cited by 12 publications

References 18 publications

Estrogen receptor (ESR1) mutation in bone metastases from breast cancer

Estrogen receptor (ESR1) mutation in bone metastases from breast cancer

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

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

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