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Adherence to clinical practice guidelines for adjuvant therapy of breast cance.

716 Background: Discrepancy has been observed between consensus recommendations and actual use of adjuvant chemotherapy in women with breast cancer. The objective of this study was to evaluate adherence to local clinical practice guidelines for breast cancer at a regional cancer centre.


METHODS
A retrospective review of patients treated between June 2001 and June 2003 was undertaken.


RESULTS
165 charts were reviewed. 23 patients were referred for radiotherapy only. 10 had metastatic disease. Of the remaining 132 patients, 1 patient was not assessed for hormone therapy due to lack of hormone receptor staining. 6 did not have axillary lymph node dissection. 126 patients were assessed for chemotherapy. The median age was 64.2 years. Guideline adherence rates are summarized in the table. Reasons for non-adherence when the guidelines recommended adjuvant hormone therapy were: patient's choice (50%), co-morbidities (20%), clinician's judgment (20%), and elderly age (10%). Reasons for non-adherence when the guidelines recommended adjuvant chemotherapy were: co-morbidities (35%), patient's choice (24%), elderly age (24%), clinician's judgment (12%), and active infection (6%). 1 patient received chemotherapy despite guideline recommendations, based on clinician's judgment.


CONCLUSIONS
Adherence to guidelines recommending adjuvant therapy is unlikely to be uniform due to patient choice and co-morbidities. At our institution, adherence to guidelines was nearly complete when no adjuvant therapy was recommended. [Figure: see text] No significant financial relationships to disclose.