Compliance with clinical guidelines for breast cancer management: A population-based study of quality-of-care indicators in France.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
03
07
2019
accepted:
09
10
2019
entrez:
24
10
2019
pubmed:
24
10
2019
medline:
17
3
2020
Statut:
epublish
Résumé
The European Society of Breast Cancer Specialists (EUSOMA), which aims to standardize the quality of patient care in Europe, has defined quality indicators (QIs) for breast cancer (BC) care to assess compliance to current care standards. These QIs are a useful tool to evaluate care organizations. Only population-based studies are able to assess health system performance in "real-life" situations. This population-based study aimed to describe compliance with several EUSOMA QIs overall and according to patient and organizational factors in France. 1 560 adult women with primary invasive non-metastatic BC diagnosed in 2012 were randomly selected among all incident BC from 16 French geographical areas covered by cancer registries. Twelve EUSOMA QIs were selected regarding diagnosis, treatment and staging. The minimum standard as proposed by EUSOMA was met for nine QIs related to pre-operative definitive diagnosis, multidisciplinary discussion and treatment (single surgery, breast conserving surgery (BCS) for small BC (<3cm), radiotherapy after BCS or mastectomy for regional BC (pN≥2a), hormonotherapy, adjuvant chemotherapy and trastuzumab). Low compliance was observed for sentinel lymph node biopsy (SLNB) and staging imaging. Adherence to guidelines was usually lower in older patients and in patients with comorbidities. Multidisciplinary discussion was positively related to adherence to guidelines for diagnosis, staging practices (SNLB, imaging) and systemic treatments. Compliance also varied by area of residence and by place of first treatment. This study provides the first current, comprehensive overview of BC quality care at a population level in France. The guidelines were correctly applied in percentage satisfying the EUSOMA standards for the diagnosis and treatment of BC, although staging practices (SLNB, imaging) can be improved. These results highlight the need for continuous measurement of adherence to guidelines to improve BC care.
Sections du résumé
BACKGROUND
The European Society of Breast Cancer Specialists (EUSOMA), which aims to standardize the quality of patient care in Europe, has defined quality indicators (QIs) for breast cancer (BC) care to assess compliance to current care standards. These QIs are a useful tool to evaluate care organizations. Only population-based studies are able to assess health system performance in "real-life" situations. This population-based study aimed to describe compliance with several EUSOMA QIs overall and according to patient and organizational factors in France.
METHODS
1 560 adult women with primary invasive non-metastatic BC diagnosed in 2012 were randomly selected among all incident BC from 16 French geographical areas covered by cancer registries. Twelve EUSOMA QIs were selected regarding diagnosis, treatment and staging.
RESULTS
The minimum standard as proposed by EUSOMA was met for nine QIs related to pre-operative definitive diagnosis, multidisciplinary discussion and treatment (single surgery, breast conserving surgery (BCS) for small BC (<3cm), radiotherapy after BCS or mastectomy for regional BC (pN≥2a), hormonotherapy, adjuvant chemotherapy and trastuzumab). Low compliance was observed for sentinel lymph node biopsy (SLNB) and staging imaging. Adherence to guidelines was usually lower in older patients and in patients with comorbidities. Multidisciplinary discussion was positively related to adherence to guidelines for diagnosis, staging practices (SNLB, imaging) and systemic treatments. Compliance also varied by area of residence and by place of first treatment.
CONCLUSION
This study provides the first current, comprehensive overview of BC quality care at a population level in France. The guidelines were correctly applied in percentage satisfying the EUSOMA standards for the diagnosis and treatment of BC, although staging practices (SLNB, imaging) can be improved. These results highlight the need for continuous measurement of adherence to guidelines to improve BC care.
Identifiants
pubmed: 31644603
doi: 10.1371/journal.pone.0224275
pii: PONE-D-19-18787
pmc: PMC6808419
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0224275Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Mod Pathol. 2010 May;23 Suppl 2:S60-4
pubmed: 20436504
Ann Oncol. 2015 Sep;26 Suppl 5:v8-30
pubmed: 26314782
Int J Qual Health Care. 2012 Aug;24(4):411-8
pubmed: 22597705
Eur J Cancer. 2017 Nov;85:15-22
pubmed: 28881247
Breast Cancer Res Treat. 2019 Jun;175(3):585-594
pubmed: 30847727
J Clin Oncol. 2007 May 10;25(14):1858-69
pubmed: 17488984
World J Surg Oncol. 2013 Mar 16;11:70
pubmed: 23497270
Eur J Surg Oncol. 2015 Oct;41(10):1423-9
pubmed: 26278019
Breast. 2012 Jun;21(3):253-60
pubmed: 22056787
Breast J. 2015 Sep-Oct;21(5):473-80
pubmed: 26133235
Clin Breast Cancer. 2019 Jun;19(3):157-164
pubmed: 30819504
BMC Health Serv Res. 2013 Jan 25;13:28
pubmed: 23351327
Eur J Cancer. 2010 Sep;46(13):2344-56
pubmed: 20675120
Am J Clin Oncol. 2012 Apr;35(2):130-5
pubmed: 21325935
J Eval Clin Pract. 2016 Feb;22(1):62-70
pubmed: 26290172
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
J Am Geriatr Soc. 2014 Mar;62(3):482-8
pubmed: 24512124
Eur J Surg Oncol. 2016 Jan;42(1):51-8
pubmed: 26490007
J Clin Oncol. 2008 Apr 10;26(11):1893-8
pubmed: 18398155
Tumori. 2012 Mar-Apr;98(2):204-9
pubmed: 22677985
CMAJ. 2015 Sep 8;187(12):E387-97
pubmed: 26100841
J Geriatr Oncol. 2017 Nov;8(6):397-402
pubmed: 28602710
Eur J Cancer. 2017 Nov;86:59-81
pubmed: 28963914
Cancer J. 2015 Jan-Feb;21(1):7-10
pubmed: 25611773
Eur J Cancer. 2012 Sep;48(13):1947-56
pubmed: 22483323
Arch Gynecol Obstet. 2012 Jun;285(6):1671-83
pubmed: 22314433
Br J Cancer. 2017 May 23;116(11):1394-1401
pubmed: 28441385
Surg Oncol. 2017 Dec;26(4):359-367
pubmed: 29113653
Springerplus. 2014 Apr 05;3:176
pubmed: 24790821
Int J Med Inform. 2019 May;125:102-109
pubmed: 30914174
Am J Surg. 2015 Dec;210(6):1147-54.e2; discussion 1153-4
pubmed: 26518161
BMC Cancer. 2008 Dec 02;8:358
pubmed: 19055735
Breast. 2015 Apr;24(2):118-23
pubmed: 25515645
J Oncol Pract. 2015 Jan;11(1):62-8
pubmed: 25392522
BMC Health Serv Res. 2015 Jan 22;15:35
pubmed: 25609420
J Clin Oncol. 2010 May 10;28(14):2396-403
pubmed: 20351324
Eur J Cancer. 2015 Jul;51(10):1221-30
pubmed: 25892645
Tumori. 2011 Sep-Oct;97(5):559-63
pubmed: 22158483
CA Cancer J Clin. 2018 Nov;68(6):394-424
pubmed: 30207593
Breast. 2014 Aug;23(4):364-70
pubmed: 24582455
JAMA Surg. 2014 Dec;149(12):1296-305
pubmed: 25390819
J Clin Oncol. 2008 Jul 20;26(21):3631-7
pubmed: 18640941
W V Med J. 2009 Oct;105 Spec No:34-8; quiz 39
pubmed: 19999263
J Am Coll Surg. 2014 Oct;219(4):638-45.e1
pubmed: 25086813
Ann Surg Oncol. 2013 Apr;20(4):1287-94
pubmed: 23135311
Cancer J. 2017 Jul/Aug;23(4):231-237
pubmed: 28731946