Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.
Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
Cancer Treat Rev. 2022 Mar;104:102353. doi: 10.1016/j.ctrv.2022.102353. Epub 2022 Jan 31.
Conformity with treatment guidelines should benefit patients. Studies have reported variation in adherence to breast cancer (BC) guidelines, particularly among older women. This study investigated (i) whether adherence to treatment guideline recommendations for women with non-metastatic BC improves overall survival (OS), (ii) whether that relationship varies by age.
MEDLINE and EMBASE were systematically searched for studies on guideline adherence and OS in women with non-metastatic BC, published after January 2000, which examined recommendations on breast surgery, chemotherapy, radiotherapy or endocrine therapy. Study results were summarised using narrative synthesis.
Sixteen studies met the inclusion criteria. The recommendations for each treatment covered were similar, but studies differed in their definitions of adherence. 5-year OS rates among patients having compliant treatment ranged from 91.3% to 93.2%, while rates among patients having non-compliant treatment ranged from 75.9% to 83.4%. Six studies reported an adjusted hazard ratio (aHR) for non-compliant treatment compared with compliant treatment; all concluded OS was worse among patients whose overall treatment was non-compliant (aHR range: 1.52 [1.30-1.82] to 2.57 [1.96-3.37]), but adjustment for potential confounders was limited. Worse adherence among older women was reported in 12/16 studies, but they did not provide consistent evidence on whether OS was associated with treatment adherence and age.
Individual studies reported that better adherence to guidelines improved OS among women with non-metastatic BC, but the evidence base has weaknesses including inconsistent definitions of adherence. More precise and consistent research designs, including the evaluation of barriers to adherence across the spectrum of healthcare practice, are required to fully understand guideline compliance, as well as the relationship between compliance and OS following a BC diagnosis.
遵从治疗指南应该使患者受益。有研究报告称，乳腺癌（BC）指南的遵从性存在差异，尤其是在老年女性中。本研究调查了（i）非转移性 BC 女性的治疗指南建议的遵从性是否能提高总体生存率（OS），（ii）这种关系是否因年龄而异。
系统检索了 2000 年 1 月以后发表的关于非转移性 BC 女性指南遵从性和 OS 的 MEDLINE 和 EMBASE 研究，这些研究检查了关于乳房手术、化疗、放疗或内分泌治疗的建议。使用叙述性综合法总结研究结果。
16 项研究符合纳入标准。各项治疗建议的推荐内容相似，但研究在遵从性定义上存在差异。接受符合治疗建议的患者的 5 年 OS 率从 91.3%到 93.2%不等，而接受不符合治疗建议的患者的 OS 率从 75.9%到 83.4%不等。有 6 项研究报告了与符合治疗相比，不符合治疗的调整后的危险比（aHR）；所有研究均得出结论，总体治疗不符合的患者 OS 较差（aHR 范围：1.52[1.30-1.82]至 2.57[1.96-3.37]），但对潜在混杂因素的调整有限。16 项研究中有 12 项报告了老年女性的遵从性较差，但他们没有提供一致的证据表明 OS 是否与治疗遵从性和年龄有关。
个别研究报告称，非转移性 BC 女性的指南遵从性提高可改善 OS，但证据基础存在缺陷，包括对遵从性的定义不一致。需要更精确和一致的研究设计，包括评估整个医疗保健实践范围内的遵从性障碍，以充分了解指南遵从性以及 BC 诊断后遵从性与 OS 之间的关系。
