Are the recommendations of the French consensus conference on the management of colon cancer followed up?
The aim of this study was to determine how the guidelines published after this conference have spread. Pretherapeutic evaluation and treatment were assessed for all colon cancers diagnosed in a well-defined French population in 2000. Patients were classified either as managed according to the recommendations, or as undermanaged or overmanaged. Outside the emergency context, pretherapeutic work-up was classified as in conformity with the consensus in 48.0% of the cases, as undervalued in 21.9% and as overvalued in 30.1%. The resection rate at 90% was not far from the optimum. Pathological data allowed us to classify nearly all cases according to the tumour node metastasis classification; however, the number of examined nodes was below the recommendations in 30.8% of cases. Chemotherapy was performed according to the recommendations in 71.4% of cases, 23.1% were undertreated and 5.5% were overtreated. The multivariate analysis indicates that patients aged 75 years or more were less likely to receive chemotherapy than was recommended (P<0.001). This study suggested that the main reasons for not following guideline recommendations were inertia due to previous practices, difficulty to perform a recommended behaviour and lack of familiarity.
Lepage
Côme
C
University of Burgundy, Cancer Registry of Burgundy, INSERM EPI 0106, Dijon, France. come.lepage@u-bourgogne.fr
Bouvier
Anne-Marie
AM
Binquet
Christine
C
Dancourt
Vincent
V
Coatmeur
Olivier
O
Faivre
Jean
J
D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000628:therapy*; D003113:Colonoscopy / Q000706:statistics & numerical data; D003245:Consensus Statements as Topic; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006287:Health Planning Guidelines; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis / Q000628:therapy; D009367:Neoplasm Staging / Q000379:methods
D000970:Antineoplastic Agents