title: Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours.
abstract: OBJECTIVE
  To evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).
  
  
  METHODS
  Data concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.
  
  
  RESULTS
  Among 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.
  
  
  CONCLUSIONS
  Guidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.
authors.affiliation: Department of Cancer Medicine, University of Paris Sud, Institut Gustave Roussy, Villejuif, France.
authors.forename: Constance
authors.initials: C
authors.lastname: Thibault
authors.affiliation: Department of Cancer Medicine, University of Paris Sud, Institut Gustave Roussy, Villejuif, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Fizazi
authors.affiliation: Department of Cancer Medicine, University of Paris Sud, Institut Gustave Roussy, Villejuif, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Barrios
authors.affiliation: Department of Cancer Medicine, University of Paris Sud, Institut Gustave Roussy, Villejuif, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Massard
authors.affiliation: Department of Cancer Medicine, University of Paris Sud, Institut Gustave Roussy, Villejuif, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Albiges
authors.affiliation: Department of Urology, Saint-Joseph Hospital, Paris, France.
authors.forename: Herve
authors.initials: H
authors.lastname: Baumert
authors.affiliation: Department of Urology, Kremlin-Bicêtre Hospital, University of Paris-Sud, Kremlin-Bicêtre, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
authors.affiliation: Department of Cancer Medicine, University of Paris Sud, Institut Gustave Roussy, Villejuif, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Escudier
authors.affiliation: Department of Cancer Medicine, University of Paris Sud, Institut Gustave Roussy, Villejuif, France. Electronic address: yohann.loriot@igr.fr.
authors.forename: Yohann
authors.initials: Y
authors.lastname: Loriot
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009373:Neoplasms, Germ Cell and Embryonal / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000592:standards*; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Adult; Germ-cell tumours; Guidelines; Neoplasms