Study Reveals Disconnect Between Patient Treatment and Evidence-Based Guidelines

Nearly half of older women with advanced breast cancer in the United States failed to receive radiation following a mastectomy, even though evidence-based guidelines suggest the treatment saves lives.

Using the Surveillance, Epidemiology and End Results (SEER)-Medicare database, researchers at the MD Anderson Cancer Center in Houston, Texas, reviewed data from 38,322 women with high-risk breast cancer who had mastectomies between 1992 and 2005. Forty-five percent of the women who received mastectomies between 1999 and 2005 did not receive postmastectomy radiation therapy (PMRT). During the same 6-year period, the overall use of PMRT did not increase, either.

These findings come despite the publication of evidence-based guidelines between 1999 and 2002 that supported PMRT. The guidelines were published by the National Cancer Institute, the American Society for Clinical Oncology, and the National Comprehensive Cancer Network.

According to MD Anderson, the organizations based their guidelines on 3 significant randomized control trials demonstrating that PMRT reduced locoregional recurrence and increased survival rates in women with advanced breast cancer.

“There’s a clear gap between the scientific evidence demonstrating PMRT’s benefits and the proper use of the therapy in everyday clinical practice,” Benjamin Smith, MD, assistant professor in the Department of Radiation Oncology at MD Anderson and lead author of the study said in a press release. “Women with advanced breast cancer benefit the most from PMRT, but for some reason they’re simply not getting it,” Smith added.

Addressing potential solutions to the disconnect between the guidelines and treatment, Smith said, “While we need to identify and correct the treatment barriers, physician accountability is necessary to ensure women receive optimal care.”

The study offered several recommendations for increasing physician adherence to PMRT guidelines, including:

• Add compliance with the guidelines as an accreditation requirement.
• Create financial incentives for following evidence-based guidelines.
• Use electronic medical records to facilitate government measurement of compliance with guidelines.
• Encourage cancer organizations such as ASCO and ASTRO to promote PMRT use to their membership.

Shirvani S, Pan I , Buchholz T, et al. Impact of evidence-based clinical guidelines on the adoption of postmastectomy radiation in older women. [published online ahead of print June 27, 2011]. Cancer. doi: 10.1002/cncr.26081.