Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia.
Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Heidelberglaan, Utrecht, the Netherlands.
JCO Glob Oncol. 2022 Mar;8:e2100314. doi: 10.1200/GO.21.00314.
Addressing unwarranted clinical variation in oncology practices is expected to lead to improved cancer outcomes. Particularly, the application and impact of treatment guidelines on breast cancer outcomes are poorly studied in resource-limited settings. We measured adherence to a set of locally developed adjuvant treatment guidelines in a middle-income setting. Importantly, the impact of guidelines adherence on survival following breast cancer was determined.
Data of 3,100 Malaysian women with nonmetastatic breast cancer diagnosed between 2010 and 2017 were analyzed. Adherence to the Malaysian Clinical Practice Guidelines for Management of Breast Cancer second Edition was measured. Outcomes comprised overall survival and event-free survival.
Guideline adherence for chemotherapy, radiotherapy, hormonal therapy, and targeted therapy were 61.7%, 79.2%, 85.1%, and 26.2%, respectively. Older age was generally associated with lower adherence to guidelines. Compared with patients who were treated according to treatment guidelines, overall survival and event-free survival were substantially lower in patients who were not treated accordingly; hazard ratios for all-cause mortality were 1.69 (95% CI, 1.29 to 2.22), 2.59 (95% CI, 1.76 to 3.81), 3.08 (95% CI, 1.94 to 4.88), and 4.48 (95% CI, 1.98 to 10.13) for chemotherapy, radiotherapy, hormone therapy, and targeted therapy, respectively. Study inferences remain unchanged following sensitivity analyses.
Our study findings appear to suggest that adherence to treatment guidelines that have been adapted for resource-limited settings may still provide effective guidance in improving breast cancer outcomes.
减少肿瘤学实践中的不合理临床差异有望改善癌症治疗效果。特别是，在资源有限的环境中，治疗指南对乳腺癌治疗效果的应用和影响研究甚少。我们在中等收入环境下，评估了一套局部制定的辅助治疗指南的应用情况。重要的是，我们确定了遵循指南与乳腺癌患者生存结果之间的关系。
我们分析了 2010 年至 2017 年间在马来西亚被诊断患有非转移性乳腺癌的 3100 名女性患者的数据。我们评估了马来西亚《乳腺癌临床管理实践指南》第二版的应用情况。研究结果包括总生存和无事件生存。
化疗、放疗、激素治疗和靶向治疗的指南遵循率分别为 61.7%、79.2%、85.1%和 26.2%。一般来说，年龄较大与较低的指南遵循率相关。与根据治疗指南进行治疗的患者相比，未按指南进行治疗的患者的总生存和无事件生存显著降低；全因死亡率的风险比分别为 1.69（95%CI，1.29 至 2.22）、2.59（95%CI，1.76 至 3.81）、3.08（95%CI，1.94 至 4.88）和 4.48（95%CI，1.98 至 10.13），分别对应化疗、放疗、激素治疗和靶向治疗。敏感性分析后，研究结论保持不变。
我们的研究结果似乎表明，遵循针对资源有限环境进行调整的治疗指南，仍然可以为改善乳腺癌治疗效果提供有效指导。
