Impact of clinical practice guidelines on the management for carcinomas of unknown primary site: a controlled "before-after" study.
BACKGROUND
In 2002, the French Federation of Comprehensive Cancer Centers published clinical practice guidelines (CPGs) for the management of carcinomas of unknown primary (CUP).


METHODS
A controlled "before-after" study at two centers (experimental in Lyon, France and control in Edmonton, Canada) to assess the impact of CPGs on CUP management. Fifty-CUP patients treated in 2000-2001, i.e. before CPG publication, and 50 patients treated in 2003-2004, were analyzed for both centers.


RESULTS
In both groups, compliance for diagnostic workup was the same before or after CPGs publication. Non-adenocarcinoma histology and performance status (PS) < 2 were independent factors for CPGs compliance. In the experimental group, 75% of patients underwent inappropriate investigations. The proportion of patients from this group with unfavourable clinicopathologic entity and PS < or = 1, who received cisplatin-based chemotherapy did not significantly change (2000-2001: 27% vs. 2003-2004: 37.5%; P = 0.45). However, most patients treated in the pre period received organ-specific regimens, while most patients treated in the post period received taxane or gemcitabine-based regimens. Patients from the control group generally received taxane/carboplatin.


CONCLUSIONS
Our study show that simply distributing CUP CPGs did not change practice and underline the necessity to disseminate and implement CPGs, both to oncologists and organ-specialist physicians.
Université de Lyon, Lyon 69008, France. pascal.seve@chu-lyon.fr
P
P
Sève
J
J
Mackey
M
M
Sawyer
T
T
Lesimple
C
C
de La Fouchardière
C
C
Broussolle
C
C
Dumontet
I
I
Ray-Coquard
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002945:Cisplatin / Q000627:therapeutic use; D005260:Female; D005602:France; D019983:Guideline Adherence; D006801:Humans; D017567:Karnofsky Performance Status; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D017410:Practice Guidelines as Topic; D011379:Prognosis; D019564:Unnecessary Procedures / Q000706:statistics & numerical data
D000970:Antineoplastic Agents; D002945:Cisplatin