Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Deparment of Surgery, Leids University Medical Center, Leiden, the Netherlands.
Pancreatology. 2020 Dec;20(8):1723-1731. doi: 10.1016/j.pan.2020.10.032. Epub 2020 Oct 10.
Compliance with national guidelines on pancreatic cancer management could improve patient outcomes. Early compliance with the Dutch guideline was poor. The aim was to assess compliance with this guideline during six years after publication.
Nationwide guideline compliance was investigated for three subsequent time periods (2012-2013 vs. 2014-2015 vs. 2016-2017) in patients with pancreatic cancer using five quality indicators in the Netherlands Cancer Registry: 1) discussion in multidisciplinary team meeting (MDT), 2) maximum 3-week interval from final MDT to start of treatment, 3) preoperative biliary drainage when bilirubin >250 μmol/L, 4) use of adjuvant chemotherapy, and 5) chemotherapy for inoperable disease (non-metastatic and metastatic).
In total, 14 491 patients were included of whom 2290 (15.8%) underwent resection and 4561 (31.5%) received chemotherapy. Most quality indicators did not change over time: overall, 88.8% of patients treated with curative intent were discussed in a MDT, 42.7% were treated with curative intent within the 3-week interval, 62.7% with a resectable head tumor and bilirubin >250 μmol/L underwent preoperative biliary drainage, 57.2% received chemotherapy after resection, and 36.6% with metastatic disease received chemotherapy. Only use of chemotherapy for non-metastatic, non-resected disease improved over time (23.4% vs. 25.6% vs. 29.7%).
Nationwide compliance to five quality indicators for the guideline on pancreatic cancer management showed little to no improvement during six years after publication. Besides critical review of the current quality indicators, these outcomes may suggest that a nationwide implementation program is required to increase compliance to guideline recommendations.
遵守国家胰腺癌管理指南可改善患者预后。早期对荷兰指南的依从性较差。本研究旨在评估该指南发布后 6 年内的依从情况。
使用荷兰癌症登记处的 5 项质量指标，评估连续 3 个时期（2012-2013 年、2014-2015 年和 2016-2017 年）内胰腺癌患者的指南依从性：1）多学科团队会议（MDT）讨论；2）MDT 结束到开始治疗的最长 3 周间隔；3）胆红素＞250μmol/L 时行术前胆道引流；4）辅助化疗；5）不可切除疾病（非转移性和转移性）的化疗。
共纳入 14491 例患者，其中 2290 例（15.8%）接受了切除术，4561 例（31.5%）接受了化疗。大多数质量指标随时间变化不大：总体而言，88.8%的根治性治疗患者在 MDT 中进行了讨论，42.7%的患者在 3 周内接受了治疗，62.7%的可切除头部肿瘤且胆红素＞250μmol/L的患者行术前胆道引流，57.2%的患者在手术后接受了化疗，36.6%的转移性疾病患者接受了化疗。仅非转移性、不可切除疾病的化疗使用率随时间增加（23.4%、25.6%、29.7%）。
该指南发布后 6 年内，胰腺癌管理指南的 5 项质量指标的全国依从性几乎没有改善。除了对当前质量指标进行严格审查外，这些结果可能表明需要实施全国性实施计划，以提高对指南建议的依从性。
