title: Impact of treatment guidelines and implementation of a quality assurance program on quality of care in endometrial cancer.
abstract: BACKGROUND
  The treatment guidelines in the last decade have shown a trend towards increasing surgical radicality in endometrial cancer. Little information is available on the implementation of standards into clinical reality. We evaluated the adherence to standard therapy before and after introduction of an internal quality management system and determined the reasons for non-adherence.
  
  
  METHODS
  A retrospective analysis of the inhouse tumor registry was performed. Included were all patients with Federation of Gynecology and Obstetrics (FIGO) I-III endometrial cancer and therapy at the Dr. Horst Schmidt Klinik (HSK) from 1997 to 2007.
  
  
  RESULTS
  206 patients with epithelial endometrial cancer in stage FIGO I-III underwent primary surgery at the HSK. 140 (68%) patients were operated as recommended by the guidelines. 20% of patients were operated less radically (17% vs. 22% before and after introduction of guidelines; p = 0.33) and 12% more radically. The latter was significantly reduced after implementation of quality management (21% vs. 7%; p = 0.004). Comorbidities and age played an important role in less-than-standard treatment.
  
  
  CONCLUSIONS
  Adherence to guideline-based therapy for endometrial cancer can be achieved in most patients. Implementation of standards and quality assurance primarily helps to avoid surgical overtreatment but failed to reduce less-than-standard treatment radicality. The latter seemed to be more defined by patient characteristics than by institution standards.
authors.affiliation: Klinik für Gynakologie & Gynäkologische Onkologie, Dr. Horst Schmidt Klinik, Wiesbaden, Germany. Prof.duBois@googlemail.com
authors.forename: Andreas
authors.initials: A
authors.lastname: du Bois
authors.forename: Deivis
authors.initials: D
authors.lastname: Strutas
authors.forename: Christine
authors.initials: C
authors.lastname: Buhrmann
authors.forename: Alexander
authors.initials: A
authors.lastname: Traut
authors.forename: Nina
authors.initials: N
authors.lastname: Ewald-Riegler
authors.forename: Stefan
authors.initials: S
authors.lastname: Kommoss
authors.forename: Ruth
authors.initials: R
authors.lastname: Gomez
authors.forename: Phillip
authors.initials: P
authors.lastname: Harter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008495:Medical Oncology / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000592:standards*; D012189:Retrospective Studies; D055815:Young Adult