title: Impact of guideline conformity on breast cancer therapy: results of a 13-year retrospective cohort study.
abstract: BACKGROUND
  To date, few studies have investigated whether the implementation of national breast cancer guidelines fulfills the goal to optimize the national standard of care. Therefore, we aimed to evaluate retrospectively the guideline-related 13-year data on breast cancer patients treated at our institution.
  
  
  METHODS
  In a retrospective cohort study, the records of a total of 2,231 patients with primary breast cancer treated during the period of 1992-2005 at the Department of Obstetrics and Gynecology, University of Ulm, Germany, were analyzed. Based on the German national Step 3 (S3) guideline, a model was created to classify groups according to therapy 'conforming' and 'non-conforming' to guideline recommendations.
  
  
  RESULTS
  In 2005, 70.2% of all patients included received both surgical and systemic adjuvant therapies conforming to the guideline. Guideline-conforming treatment was accompanied with significant advantages in terms of recurrence-free survival (RFS) and overall survival (OAS) rates.
  
  
  CONCLUSIONS
  It has to be demanded that breast cancer patients are treated in conformity with the S3 guidelines. The reasons for a treatment not conforming to the guidelines should be analyzed for the detection of barrier factors, in order to optimize adherence to the guidelines and therefore to prolong RFS and OAS.
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany. achim.woeckel@uniklinik-ulm.de
authors.forename: Achim
authors.initials: A
authors.lastname: Wöckel
authors.forename: Dominic
authors.initials: D
authors.lastname: Varga
authors.forename: Ziad
authors.initials: Z
authors.lastname: Atassi
authors.forename: Christian
authors.initials: C
authors.lastname: Kurzeder
authors.forename: Regine
authors.initials: R
authors.lastname: Wolters
authors.forename: Manfred
authors.initials: M
authors.lastname: Wischnewsky
authors.forename: Christine
authors.initials: C
authors.lastname: Wulff
authors.forename: Rolf
authors.initials: R
authors.lastname: Kreienberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D044584:Carcinoma, Ductal / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018275:Carcinoma, Lobular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D019317:Evidence-Based Medicine; D005260:Female; D005858:Germany; D019983:Guideline Adherence; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies