The association between population-based treatment guidelines and adjuvant therapy for node-negative breast cancer

Abstract

C Sawka1 2, 3,4, I Olivotto5,6, A Coldman6,7, V GoeJ3,4,8 Summary This study evaluated the impact of province-wide treatment guidelines on consistency of adjuvant therapy for node-negative breast cancer. A retrospective population-based cohort study was conducted in the Canadian provinces of British Columbia, which has provincewide guidelines, and Ontario, which does not. All eligible 1991 incident cases of node-negative breast cancer in British Columbia (n = 942) and a similar number of randomly selected 1991 incident cases in Ontario (n = 938) were reviewed. Consistency of adjuvant therapy received was evaluated by stratifying cases into discrete diagnostic groups using several grouping systems, and by then comparing the distribution of treatments received within each diagnostic group in the two provinces. Recursive partitioning was also performed. We observed that patterns of pathology reporting were consistent with awareness of the factors used in the British Columbia guidelines to define indications for adjuvant therapy. Consistency of care was greater in British Columbia than in Ontario by all diagnostic grouping systems and by recursive partitioning (P < 0.001), and the observed patterns in British Columbia corresponded to the British Columbia guidelines. We conclude that populationbased treatment guidelines can play a role in promoting consistent patterns of adjuvant therapy for women with node-negative breast cancer.

Risk of early recurrence among postmenopausal women with estrogen receptor‐positive early breast cancer treated with adjuvant tamoxifen

“…Patients underwent definitive surgery, including axillary lymph node dissection, and received adjuvant radiation and systemic therapy as described in the BCCA cancer management guidelines, which evolved over time. [15][16][17] Data were abstracted from the prospectively assembled BCCA Breast Cancer Outcomes Unit database, which contains demographic, pathologic, staging, treatment, and outcomes information on all patients who have been diagnosed with breast cancer since January 1, 1989 and referred to a BCCA facility. Pathology characteristics abstracted included lymph node status (positive or negative), the number of axillary lymph nodes removed and involved with cancer, tumor size, histologic grade, ER status, and the presence of lymphatic or vascular invasion in the primary tumor (Table 1).…”

Social, Prognostic, and Therapeutic Factors Associated with Cancer Survival: A Population-Based Study in Metropolitan Detroit, Michigan

“…a All adjusted for age (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74)75 years or older) and other factors in the model.…”

“…For example, in the United States, such social factors as SES and race are both highly associated with cancer prognostic and treatment factors, [18][19][20][21][22][23][24][25] which themselves are highly associated with cancer survival in the United States and other countries. [26][27][28] Moreover, the associations of social factors with tumor biology in the United States [29][30][31][32] and the associations of social factors with prognosis and treatment in other countries, including Canada, [33][34][35][36] have all been observed to be extremely small or nonsignificant. Separately, each of these meta-estimates seems to be most consistent with a systemic, rather than an individual biological-behavioral, account.…”

Role of radiation therapy in patients with a diagnosis of both systemic lupus erythematosus and cancer

“…However, in a radiation practice, these cases are not common. In the province of British Columbia, only 5 of the 939 patients (0.5%) with node-negative invasive breast cancer diagnosed in the year 1991 had a diagnosis of SLE or "vasculitis" (15). A review of the recent literature is summarized in Table 4.…”