Practice Patterns and Guideline Adherence of Medical Oncologists in Managing Patients with Early Breast Cancer

Background

Studies of adherence to breast cancer guidelines have often focused on primary therapies, but concordance with other guideline recommendations has not been examined as extensively. This study assesses the knowledge and practice patterns of medical oncologists in the United States to inform education and quality improvement initiatives that can improve breast cancer care.

Methods

A survey containing case vignettes and related questions was developed to examine oncologists' clinical decision-making in evaluating and treating women with early breast cancer. The instrument was distributed to a random sample of 742 oncologists in the United States and yielded 205 responses (27.6% response rate). Responses from 184 practicing medical oncologists were analyzed relative to the 2007 NCCN Clinical Practice Guidelines in Oncology: Breast Cancer.

Results

Most oncologists made guideline-consistent choices in clarifying indeterminate human epidermal growth factor 2 (HER2) status (85%), initial treatment for early breast cancer (95%), and postsurgical management of locally advanced breast cancer (82%). Guideline-discordant choices were seen in the lack of clip placement before neoadjuvant chemotherapy (36%), unnecessary use of PET scanning for initial assessment (34%), inappropriate assessment of menopausal status (33%), inappropriate use of tumor markers (22%), and use of chest imaging (16%) during posttherapeutic surveillance.

Conclusions

Oncologists often make guideline-consistent choices, but discordant clinical decisions may occur in important aspects of care for early breast cancer. Broadening the diffusion and adoption of guideline recommendations is an important mechanism for addressing these gaps and may substantially improve the quality of breast cancer care.

If the inline PDF is not rendering correctly, you can download the PDF file here.

Correspondence: Jill Foster, MD, MPH, Outcomes, Inc., 107 Frankfurt Circle, Birmingham, AL 35211. E-mail: jill.foster@ceoutcomes.com

Article Sections

References

  • 1

    American Cancer Society. Breast Cancer Facts and Figures 2007-2008. American Cancer Society: Atlanta, GA.

  • 2

    RiesLMelbertDKrapchoM. SEER Cancer Statistics Review 1975-2005 National Cancer Institute. 2008National Cancer Institute: Bethesda, MD.

    • Search Google Scholar
    • Export Citation
  • 3

    FieldMMLohrKN. Clinical Practice Guidelines: Direction for a New Program. Institute of Medicine, Committee on Clinical Practice Guidelines: Washington, DC; 1990.

    • Search Google Scholar
    • Export Citation
  • 4

    BickellNALeParRWongJBLeventhalH. Lost opportunities: physicians’ reasons and disparities in breast cancer treatment. J Clin Oncol2007;25:25162521.

    • Search Google Scholar
    • Export Citation
  • 5

    GriggsJJCulakovaESorberoMF. Social and racial differences in selection of breast cancer adjuvant chemotherapy regimens. J Clin Oncol2007:25: 25222527.

    • Search Google Scholar
    • Export Citation
  • 6

    LandercasperJDietrichLLJohnsonJM. A breast center review of compliance with National Comprehensive Cancer Network Breast Cancer Guidelines. Am J Surg2006;192:525527.

    • Search Google Scholar
    • Export Citation
  • 7

    PeabodyJWLuckJGlassmanP. Comparison of vignettes, standardized patients, and chart abstraction: a prospective validation study of 3 methods for measuring quality. JAMA2000;283:17151722.

    • Search Google Scholar
    • Export Citation
  • 8

    VeloskiJToiSEvansASNashDB. Clinical vignette-based surveys: a tool for assessing physician practice variation. Am J Med Qual2005;20:151157.

    • Search Google Scholar
    • Export Citation
  • 9

    CarlsonRWAndersonBOBursteinHJ. NCCN Clinical Practice Guidelines in Oncology Breast Cancer v.1.2007. Accessed October 2007. To view the most recent and complete version of the NCCN guidelines go online to www.nccn.org.

    • Search Google Scholar
    • Export Citation
  • 10

    Hebert-CroteauNBrissonJLatreilleJ. Compliance with consensus recommendations for systemic therapy is associated with improved survival of women with node-negative breast cancer. J Clin Oncol2004;22:36853693.

    • Search Google Scholar
    • Export Citation
  • 11

    LashTLClough-GorrKSillimanRA. Reduced rates of cancer-related worries and mortality associated with guideline surveillance after breast cancer therapy. Breast Cancer Res Treat2005;89:6167.

    • Search Google Scholar
    • Export Citation
  • 12

    LashTLSillimanRAGuadagnoliEMorV. The effect of less than definitive care on breast carcinoma recurrence and mortality. Cancer2000;89:17391747.

    • Search Google Scholar
    • Export Citation
  • 13

    MinterRMSpenglerKKToppingDP. Institutional validation of breast cancer treatment guidelines. J Surg Res2001;100:106109.

  • 14

    PodoloffDAAdvaniRHAllredC. NCCN Task Force Report: Positron emission tomography (PET)/computed tomography (CT) scanning in cancer. J Natl Compr Canc Netw2007;5(Suppl 1):S1S22.

    • Search Google Scholar
    • Export Citation
  • 15

    HarlanLCGreeneALCleggLX. Insurance status and the use of guideline therapy in the treatment of selected cancers. J Clin Oncol2005;23:90799088.

    • Search Google Scholar
    • Export Citation
  • 16

    JacobsonJONeussMNMcNiffKK. Improvement in oncology practice performance through voluntary participation in the Quality Oncology Practice Initiative. J Clin Oncol2008;26:18931898.

    • Search Google Scholar
    • Export Citation
  • 17

    MalinJLSchneiderEDEpsteinAM. Results of the National Initiative for Cancer Care Quality: how can we improve the quality of cancer care in the United States?J Clin Oncol2006;24:626634.

    • Search Google Scholar
    • Export Citation
  • 18

    CabanaMDRandCSPoweNR. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA1999;282:14581465.

    • Search Google Scholar
    • Export Citation
  • 19

    McClureJS. What it means to follow a guideline. J Natl Compr Canc Netw2006;4:641643.

Article Information

PubMed

Google Scholar

Related Articles

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 80 80 6
PDF Downloads 51 51 4
EPUB Downloads 0 0 0