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

Authors:
Jill A. Foster From Outcomes, Inc., Birmingham, Alabama, and National Comprehensive Cancer Network, Fort Washington, Pennsylvania.

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 MD, MPH
,
Maziar Abdolrasulnia From Outcomes, Inc., Birmingham, Alabama, and National Comprehensive Cancer Network, Fort Washington, Pennsylvania.

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 PhD
,
Hamidreza Doroodchi From Outcomes, Inc., Birmingham, Alabama, and National Comprehensive Cancer Network, Fort Washington, Pennsylvania.

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 MD
,
Joan McClure From Outcomes, Inc., Birmingham, Alabama, and National Comprehensive Cancer Network, Fort Washington, Pennsylvania.

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 MS
, and
Linda Casebeer From Outcomes, Inc., Birmingham, Alabama, and National Comprehensive Cancer Network, Fort Washington, Pennsylvania.

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 PhD
Volume/Issue:
Volume 7: Issue 7
Online Publication Date:
Jul 2009
DOI:
https://doi.org/10.6004/jnccn.2009.0049
Full access

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.

Correspondence: Jill Foster, MD, MPH, Outcomes, Inc., 107 Frankfurt Circle, Birmingham, AL 35211. E-mail: jill.foster@ceoutcomes.com
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Print ISSN:
1540-1405
Online ISSN:
1540-1413
Publisher:
National Comprehensive Cancer Network
Cover Journal of the National Comprehensive Cancer Network
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Copyright:
Copyright © 2009 by the National Comprehensive Cancer Network 2009
Page Numbers:
10
Article Category:
Research Article
Received:
02 Feb 2009
Accepted:
28 Apr 2009
Print Publication Date:
01 Jul 2009
Online Publication Date:
Jul 2009
Keywords:
Breast cancer; guideline adherence; oncologists; practice patterns; performance

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