Monitoring spontaneous adherence to therapeutic guidelines in 500 cancer patients

Abstract

6055 Background: Our institution adheres to recognized guidelines for cancer treatment (GCT) as those from NCI (USA) or NICE (UK). These are essential tools to our understanding, for monitoring quality of medical care. In a previous study, over 90% of physicians complied with these guidelines when they were included in a monitored program, however an evaluation of spontaneous (non monitored) adherence to GCT by practicing oncologists in our country is lacking and it was the purpose of the study. Methods: We retrieved from our database 500 consecutive requests for cancer treatment received from 1997 to 2004 from outside non monitored institutions. Results: The treatment received by 389 patients (78%) was according to GCT, whereas 111 (22.6%) were treated without any compliance of existing GCT’s. Major deviations from GCT were detected in this cohort, such as investigational treatments in 43 (8.6%), inadequate treatment for the actual stage of the disease 43 (8.6%), inadequate dosage: 13 (2.6%), lack of correlation between diagnosis and treatment prescribed 5 (1%) and delayed treatment 7 (1.4%). Compared to our historical series of monitored prescriptions, the likelihood of receiving an inadequate therapy significantly increased when practicing oncologists were not monitored (p=0.0001). Conclusions: When treatment was not monitored, one every five patients received an inadequate therapy either because of inaccurate treatment for stage, incorrect dosing or by utilizing investigational treatments instead of a proven one. No significant financial relationships to disclose.