Breast cancer care compared with clinical Guidelines: an observational study in France

Lebeau, Marie; Mathoulin-Pélissier, Simone; Bellera, Carine; Tunon-de-Lara, Christine; Daban, Alain; Lipinski, Francis; Jaubert, Dominique; Ingrand, Pierre; Migeot, Virginie
January 2011
BMC Public Health;2011, Vol. 11 Issue 1, p45
Academic Journal
Background: Great variability in breast cancer (BC) treatment practices according to patient, tumour or organisation of care characteristics has been reported but the relation between these factors is not well known. In two French regions, we measured compliance with Clinical Practice Guidelines for non-metastatic BC care management and identified factors associated with non-compliance at clinical and organisational levels. Methods: Eligible patients had invasive unilateral BC without distant metastases and at least two contacts with one of the two regional healthcare systems (2003-2004) in the first year after diagnosis. Medical data were collected from patient medical records in all public and private hospitals (99 hospitals). The care process was defined by 20 criteria: clinical decisions for treatment and therapeutic procedures. Each criterion was classified according to level of compliance ("Compliant", "Justifiable" and "Not Compliant") and factors of non-compliance were identified (mixed effect logistic regression). Results: 926 women were included. Non-compliance with clinical decisions for treatment was associated with older patient age (OR 2.1; 95%CI: 1.3-3.6) and region (OR 3.0; 95%CI: 1.2-7.4). Non-compliance with clinical decisions for radiotherapy was associated with lymph node involvement or the presence of peritumoural vascular invasion (OR 1.5; 95%CI: 1.01-2.3) and non-compliance with overall treatment (clinical decisions for treatment + therapeutic procedures) was associated with the presence of positive lymph nodes (OR 2.0; 95%CI: 1.2-3.3), grade III versus grade I (OR 2.9; 95%CI: 1.4-6.2), and one region of care versus another (OR 3.5; 95%CI: 1.7-7.1). Finally, heterogeneity of compliance in overall treatment sequence was identified between local cancer units (p < 0.05). Conclusion: This study provides interesting insights into factors of non-compliance in non-metastatic BC management and could lead to quality care improvements.


Related Articles

  • Retrospective evaluation of the treatment for breast cancer: how does the patient's personal experience of the treatment affect later adjustment to the illness? Alder, J.; Bitzer, J. // Archives of Women's Mental Health;2003, Vol. 6 Issue 2, p91 

    Summary.The aim of the present study was the evaluation of patients' treatment experience for breast cancer and its possible associations with the illness adjustment process. To examine perception and experience of treatment during the diagnostic and the inpatient phase, as well as during...

  • LONG-TERM OUTCOME OF BREAST PRESERVATION TECHNIQUE IN SUITABLE EARLY BREAST CANCERS. M. B., Biswa; A., Nik Min; N. I., Nik Ruzman; Z., Rozaimey; S., Syed Ejaz // Malaysian Journal of Medical Sciences;Jan2006 Supplement, Vol. 13, p41 

    PURPOSE : Early breast cancers are managed effectively with surgery and adjuvant chemotherapy and radiotherapy. Surgical intervention such as radical/modified radical mastectomy or conservative breast surgery, has gained interest in the past. However recent evidences suggest similar cure rates...

  • Non-standard management of breast cancer increases with age in the UK: a population based cohort of women 65 years. Lavelle, K.; Todd, C.; Moran, A.; Howell, A.; Bundred, N.; Campbell, M. // British Journal of Cancer;4/23/2007, Vol. 96 Issue 8, p1197 

    Evidence suggests that compared to younger women, older women are less likely to receive standard management for breast cancer. Whether this disparity persists once differences in tumour characteristics have been adjusted for has not been investigated in the UK. A retrospective cohort study...

  • Circulating tumor cells and brain metastasis outcome in patients with HER2-positive breast cancer: the LANDSCAPE trial. Pierga, J.-Y.; Bidard, F.-C.; Cropet, C.; Tresca, P.; Dalenc, F.; Romieu, G.; Campone, M.; Mahier Aït-Oukhatar, C.; Le Rhun, E.; Gonçalves, A.; Leheurteur, M.; Dômont, J.; Gutierrez, M.; Curé, H.; Ferrero, J.-M.; Labbe-Devilliers, C.; Bachelot, T. // Annals of Oncology;Dec2013, Vol. 24 Issue 12, p2999 

    Background Decrease of circulating tumor cells (CTC) during treatment is an independent prognostic factor in metastatic breast cancer (MBC). We specifically evaluated the impact of CTC on brain metastasis outcome. Methods HER2-positive MBC with brain metastasis not previously treated with...

  • Reducing unnecessary hospital days to improve quality of care through physician accountability: a cluster randomised trial. Caminiti, Caterina; Meschi, Tiziana; Braglia, Luca; Diodati, Francesca; Iezzi, Elisa; Marcomini, Barbara; Nouvenne, Antonio; Palermo, Eliana; Prati, Beatrice; Schianchi, Tania; Borghi, Loris // BMC Health Services Research;2013, Vol. 13 Issue 1, p1 

    Background: It has been documented that variations exist in breast cancer treatment despite wide dissemination of clinical practice guidelines. The aim of this population-based study was to evaluate the impact of regional guidelines (Piedmont guidelines, PGL) for breast cancer diagnosis and...

  • Comparison of Long-Term Outcomes of Postmastectomy Radiotherapy between Breast Cancer Patients with and without Immediate Flap Reconstruction. Lee, Hsin-Hua; Hou, Ming-Feng; Wei, Shu-Yi; Lin, Sin-Daw; Luo, Kuei-Hau; Huang, Ming-Yii; Ou-Yang, Fu; Huang, Chih-Jen // PLoS ONE;2/10/2016, Vol. 11 Issue 2, p1 

    Purpose: To compare the long-term clinical outcomes of postmastectomy radiotherapy (PMRT) between breast cancer patients with and without immediate transverse rectus abdominis myocutaneous (TRAM) flap reconstruction. Methods: The study included 492 patients with stage II or III breast cancer...

  • What needs to be said about the NHS. Dale, Iain // New Statesman;2/27/2015, p18 

    The author criticizes the performance and management of the British National Health Service (NHS), focusing on NHS England. He cites statistics showing that breast cancer patients have better outcomes in most other European countries than in England, saying this is due to NHS England's...

  • Highly targeted irradiation as good as whole breast radiotherapy in early stage cancer.  // Biomedical Market Newsletter;5/12/2012, Vol. 21, p1 

    The article presents information on advantages of accelerated partial breast irradiation (APBI) therapy in breast cancer treatment including better cosmetic outcomes, low cost and less side effects in comparison to conventional whole breast irradiation. Short treatment time of four to five days...

  • Studies Address Racial and Geographic Disparities in Breast Cancer Treatment. Hampton, Tracy // JAMA: Journal of the American Medical Association;10/8/2008, Vol. 300 Issue 14, p1641 

    The article discusses the different levels and different qualities of medical care people receive in 2008 based on where they live and their race, specifically examining the level of breast cancer care women receive in light of such disparities. Two breast cancer studies document the trends, the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics