Leitlinienkonformität bei der Therapie des Mammakarzinoms

Abstract

PURPOSE: The German “Step 3” (S3) interdisciplinary evidence-based consensus guidelines with recommendations for the “Diagnosis, Therapy, and Follow-up of Breast Cancer” were developed and implemented to optimize the national standard of care. Currently, these guidelines provide a basis for certifying breast centers in Germany and serve as guideline-based quality indicators for external comparative quality assurance. To date, no studies have investigated how guideline adherence impacts patient-relevant outcomes. Therefore, we aimed to analyze the impact of -national guideline adherence on patient-relevant outcomes. METHODS: In a retrospective cohort study, a total of 3976 patients first diagnosed with primary breast cancer between 2001-2005 and treated at the Department of Obstetrics and Gynecology, University of Ulm Medical Center, Germany and local affiliated certified breast centers were -analyzed according to a model created to classify patients into groups according to “guideline -adherence” and “guideline non-adherence” of therapy. RESULTS: A total of 2063 of the 3976 patients were treated in full in adherence with guideline recommendations. Violation of at least one guideline -recommendation was registered in the therapy of 1913 patients. A comparison of these two groups showed that guideline-adherent treatment had a significant impact on recurrence-free survival and overall survival (p = 0.0001). The greater the number of variations in guideline -adherence, the lower the overall survival (p = 0.0001). Advanced age at initial diagnosis was additionally associated with a reduction in guideline-adherent treatment. Most guideline vio-lations were noted for adjuvant radiotherapy and chemotherapy regimens. CONCLUSION: Patients with breast cancer should be treated in adherence with guidelines. To further optimize treatment outcomes, future studies are needed to investigate the reasons for variations in adherence with guideline recommendations and how barrier factors impact guideline implementation.