Do physicians follow systemic treatment and funding policy guidelines?
BACKGROUND
The use of bisphosphonates for the prevention of skeletal related events in women with bone metastases from breast cancer is well established. We undertook an evaluation of bisphosphonate use in clinical practice in three Canadian cancer centres. In addition we assessed whether or not physicians at these centres are following their local treatment guidelines and funding policies.


METHODS
Charts and electronic files of patients who had received either clodronate or pamidronate at any time between January 2000 and December 2001 at three Canadian cancer centres were retrospectively reviewed.


RESULTS
There has been a marked improvement in the time between the diagnosis of bone metastases and the commencement of bisphosphonates from a median of 155 days in 1998 to 24 days in 2001. However, despite a local funding policy requiring that oral clodronate be the first bisphosphonate used, this was the case in only 67% of patients. In addition, despite one centre's guidelines recommending that bisphosphonates be stopped once the patient was progressing, 90% of their patients remained on bisphosphonates until they died.


CONCLUSIONS
A considerable amount of effort is spent on the creation of "evidence based" treatment guidelines. Funding agencies develop policies based on these treatment guidelines, but often funding is more restrictive than the treatment guideline would suggest. It is clear from this review that physicians still appear to manage a substantial proportion of patients outside of funding policies, but within evidence based recommendations. Therefore, a need exists for either the creation of guidelines and policies that physicians will follow or the implementation of methods to ensure that restrictive policies are actually followed.
Clemons
Mark
M
Toronto-Sunnybrook Regional Cancer Centre, Canada. mark.clemons@sw.ca
Enright
Katherine
K
Cesta
Annemarie
A
Charbonneau
Flag
F
Chow
Edward
E
Warr
Dave
D
Kee-Cresswell
Danielle
D
Chang
Jose
J
Yogendran
Geetha
G
Trudeau
Maureen
M
De Angelis
Carlo
C
Cottrell
Wayne
W
Dranitsaris
George
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D001943:Breast Neoplasms / Q000188:drug therapy*; D004164:Diphosphonates / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D011364:Professional Practice; D012189:Retrospective Studies
D004164:Diphosphonates