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2015 ; 15
(ä): 734
Nephropedia Template TP
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The adherence paradox: guideline deviations contribute to the increased 5-year
survival of breast cancer patients
#MMPMID26481452
Jacke CO
; Albert US
; Kalder M
BMC Cancer
2015[Oct]; 15
(ä): 734
PMID26481452
show ga
BACKGROUND: In German breast cancer care, the S1-guidelines of the 1990s were
substituted by national S3-guidelines in 2003. The application of guidelines
became mandatory for certified breast cancer centers. The aim of the study was to
assess guideline adherence according to time intervals and its impact on
survival. METHODS: Women with primary breast cancer treated in three rural
hospitals of one German geographical district were included. A cohort study
design encompassed women from 1996-97 (N = 389) and from 2003-04 (N = 488).
Quality indicators were defined along inpatient therapy sequences for each time
interval and distinguished as guideline-adherent and guideline-divergent medical
decisions. Based on all of the quality indicators, a binary overall adherence
index was defined and served as a group indicator in multivariate Cox-regression
models. A corrected group analysis estimated adjusted 5-year survival curves.
RESULTS: From a total of 877 patients, 743 (85 %) and 504 (58 %) were included to
assess 104 developed quality indicators and the resuming binary overall adherence
index. The latter significantly increased from 13-15 % (1996-97) up to 33-35 %
(2003-04). Within each time interval, no significant survival differences of
guideline-adherent and -divergent treated patients were detected. Across time
intervals and within the group of guideline-adherent treated patients only,
survival increased but did not significantly differ between time intervals.
Across time intervals and within the group of guideline-divergent treated
patients only, survival increased and significantly differed between time
intervals. CONCLUSIONS: Infrastructural efforts contributed to the increase of
process quality of the examined certified breast cancer center. Paradoxically, a
systematic impact on 5-year survival has been observed for patients treated
divergently from the guideline recommendations. This is an indicator for the
appropriate application of guidelines. A maximization of guideline-based
decisions instead of the ubiquitous demand of guideline adherence maximization is
advocated.
|*Disease Management
[MESH]
|*Guideline Adherence
[MESH]
|Breast Neoplasms/*mortality/therapy
[MESH]
|Disease-Free Survival
[MESH]
|Female
[MESH]
|Follow-Up Studies
[MESH]
|Germany/epidemiology
[MESH]
|Humans
[MESH]
|Middle Aged
[MESH]
|Proportional Hazards Models
[MESH]
|Quality Indicators, Health Care/*statistics & numerical data
[MESH]