title: Impact of breast cancer treatment guidelines on surgeon practice patterns: results of a hospital-based intervention.
abstract: BACKGROUND
  Despite evidence regarding the effectiveness of post-surgical treatments for early-stage breast cancer, older women are less likely to receive appropriate therapy. We evaluated the impact of surgeon-specific "performance reports" on adherence to treatment guidelines among older women with breast cancer.
  
  
  METHODS
  We obtained diagnostic and treatment data from hospital tumor registries supplemented with self-reported adjuvant therapy information on 1099 patients with stage I or II breast cancer diagnosed between November 1, 1992, and January 31, 1997, at 6 Rhode Island hospitals. We compared rates of appropriate treatment receipt before and after distribution of performance reports. Hierarchical analysis was used to account for the nesting of patients within surgeons. Separate analyses of mastectomy and breast-conserving surgery were performed.
  
  
  RESULTS
  Age was negatively associated with post-surgical treatment, with patients who had breast-conserving surgery and who were older than 80 years significantly less likely to undergo radiation therapy (adjusted odds ratio = 0.08 [0.04, 0.14]) or appropriate adjuvant therapies (adjusted odds ratio = 0.14 [0.08, 0.22]) or both relative to 70- to 79-year-old patients. This effect did not improve post-intervention. While there was much variability in compliance with guidelines, surgeons' characteristics did not explain this variation.
  
  
  CONCLUSIONS
  In Rhode Island, advanced age continues to be associated with less than adequate breast cancer therapy. Providing surgeons with "feedback" on the appropriateness of adjuvant treatment for older patients was insufficient to alter established practices. Using guideline compliance data as standard "quality indicators" of physician practice may be required.
authors.affiliation: Center for Gerontology and Health Care Research, Brown University, and the Rhode Island Medical Foundation, Division of Geriatrics, Rhode Island Hospital, Providence, RI, USA.
authors.forename: V
authors.initials: V
authors.lastname: Mor
authors.forename: L L
authors.initials: LL
authors.lastname: Laliberte
authors.forename: A C
authors.initials: AC
authors.lastname: Petrisek
authors.forename: O
authors.initials: O
authors.lastname: Intrator
authors.forename: T
authors.initials: T
authors.lastname: Wachtel
authors.forename: P G
authors.initials: PG
authors.lastname: Maddock
authors.forename: K I
authors.initials: KI
authors.lastname: Bland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D013502:General Surgery; D006761:Hospitals; D006801:Humans; D011182:Postoperative Care / Q000592:standards; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care; D012042:Registries; D012237:Rhode Island