Adherence to breast cancer guidelines is associated with better survival outcomes : A systematic review and meta-analysis of observational studies in EU countries
Ricci-Cabello, I. (Ciber de Epidemiología y Salud Pública (CIBERESP))
Vásquez-Mejía, A. (Universidad Nacional Mayor de San Marcos (Lima, Perú))
Canelo Aybar, Carlos Gilberto (Institut d'Investigació Biomèdica Sant Pau)
Niño de Guzmán, Ena Pery (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Pérez-Bracchiglione, J. (Universidad de Valparaíso)
Rabassa Bonet, Montserrat (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Rigau, David (Institut d'Investigació Biomèdica Sant Pau)
Solà, Ivan (Institut d'Investigació Biomèdica Sant Pau)
Song, Yang (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Neamtiu, L. (Joint Research Centre (JRC))
Parmelli, Elena (European Commission. Joint Research Centre (JRC))
Saz-Parkinson, Zuleika (Joint Research Centre (JRC))
Alonso-Coello, Pablo (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona

Fecha:	2020
Resumen:	Breast cancer (BC) clinical guidelines offer evidence-based recommendations to improve quality of healthcare for patients with or at risk of BC. Suboptimal adherence to recommendations has the potential to negatively affect population health. However, no study has systematically reviewed the impact of BC guideline adherence -as prognosis factor- on BC healthcare processes and health outcomes. The objectives are to analyse the impact of guideline adherence on health outcomes and on healthcare costs. We searched systematic reviews and primary studies in MEDLINE and Embase, conducted in European Union (EU) countries (inception to May 2019). Eligibility assessment, data extraction, and risk of bias assessment were conducted by one author and crosschecked by a second. We used random-effects meta-analyses to examine the impact of guideline adherence on overall survival and disease-free survival, and assessed certainty of evidence using GRADE. We included 21 primary studies. Most were published during the last decade (90%), followed a retrospective cohort design (86%), focused on treatment guideline adherence (95%), and were at low (80%) or moderate (20%) risk of bias. Nineteen studies (95%) examined the impact of guideline adherence on health outcomes, while two (10%) on healthcare cost. Adherence to guidelines was associated with increased overall survival (HR = 0. 67, 95%CI 0. 59-0. 76) and disease-free survival (HR = 0. 35, 95%CI 0. 15-0. 82), representing 138 more survivors (96 more to 178 more) and 336 patients free of recurrence (73 more to 491 more) for every 1000 women receiving adherent CG treatment compared to those receiving non-adherent treatment at 5 years follow-up (moderate certainty). Adherence to treatment guidelines was associated with higher costs, but adherence to follow-up guidelines was associated with lower costs (low certainty). Our review of EU studies suggests that there is moderate certainty that adherence to BC guidelines is associated with an improved survival. BC guidelines should be rigorously implemented in the clinical setting. Trial registration: PROSPERO (CRD42018092884).
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Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Adherence ; Breast cancer ; Clinical guidelines ; Survival ; Systematic review
Publicado en:	BMC health services research, Vol. 20 Núm. 1 (july 2020) , p. 920, ISSN 1472-6963

DOI: 10.1186/s12913-020-05753-x
PMID: 33028324

12 p, 1.2 MB

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