Impact of treatment guidelines and implementation of a quality assurance program on quality of care in endometrial cancer.
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.
du Bois
Andreas
A
Klinik für Gynakologie & Gynäkologische Onkologie, Dr. Horst Schmidt Klinik, Wiesbaden, Germany. Prof.duBois@googlemail.com
Strutas
Deivis
D
Buhrmann
Christine
C
Traut
Alexander
A
Ewald-Riegler
Nina
N
Kommoss
Stefan
S
Gomez
Ruth
R
Harter
Phillip
P
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