title: Institutional validation of breast cancer treatment guidelines.
abstract: Several groups have developed clinical guidelines for the management of breast cancer, yet little data exist regarding their validation. Therefore, we examined the effect of published National Comprehensive Cancer Network (NCCN) guidelines for invasive breast cancer on survival, quality of life (QOL), and hospital cost. From 260 consecutive breast cancer patients, 129 patients were identified for analysis: 93 patients (72%) were treated according to the guidelines (NCCN+), while the treatment of 36 patients (28%), with a similar stage distribution, deviated from the guidelines (NCCN-). Patients were excluded from analysis with a diagnosis of carcinoma in situ, inflammatory cancer, stage IV disease, and comorbid conditions that affected treatment. The 5-year survival was 87.6% for the NCCN+ patients versus 83.3% for NCCN- patients (P = 0.319 by Kaplan-Meier). Twelve QOL parameters were evaluated using a Likert-type scale (1 = severe and 5 = none). NCCN+ patients had a cumulative QOL score of 4.18 +/- 0.08 versus 4.24 +/- 0.14 for NCCN- patients (P = 0.745). Treatment-related costs were $20,300 +/- 1800 for NCCN+ patients versus $59,700 +/- 25,200 for NCCN- patients (P = 0.016 by t test). Although deviation from NCCN breast cancer guidelines had no effect on perceived quality of life or survival, there was a significant decrease in cost in the NCCN+ group. These findings suggest that adherence to NCCN guidelines can significantly reduce the cost of breast cancer care without adversely affecting either survival or quality of life.
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, Florida 32610, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Minter
authors.forename: K K
authors.initials: KK
authors.lastname: Spengler
authors.forename: D P
authors.initials: DP
authors.lastname: Topping
authors.forename: R
authors.initials: R
authors.lastname: Flug
authors.forename: E M
authors.initials: EM
authors.lastname: Copeland
authors.forename: D S
authors.initials: DS
authors.lastname: Lind
mesh_terms: D001943:Breast Neoplasms / Q000191:economics / Q000401:mortality / Q000628:therapy*; D002278:Carcinoma in Situ / Q000191:economics / Q000401:mortality / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D017721:Hospital Costs; D006801:Humans; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D011788:Quality of Life; D015996:Survival Rate