title: Adherence to AIOM (Italian Association of Medical Oncology) lung cancer guidelines in Italian clinical practice: Results from the RIGHT-3 (research for the identification of the most effective and highly accepted clinical guidelines for cancer treatment) study.
abstract: OBJECTIVE
  Clinical practice guidelines represent a key tool to improve quality and reduce variability of cancer care. In 2004, Italian Association of Medical Oncology (AIOM) launched the RIGHT (research for the identification of the most effective and highly accepted clinical guidelines for cancer treatment) program. The third step, RIGHT-3, evaluated the concordance between AIOM lung cancer guidelines and Italian clinical practice.
  
  
  METHODS
  RIGHT-3 was a retrospective observational study, conducted in 53 Italian centers treating lung cancer. Sampling from AIOM database of 230 centers was stratified by presence of thoracic surgery and geographic distribution. To describe the adherence to AIOM guidelines (2009 edition), 11 indicators regarding diagnostic and treatment procedures were identified. Patients with non-small-cell lung cancer (NSCLC) diagnosis who had first visit in 2010 were divided into 3 groups, based on TNM stage: I-II-IIIA (5 indicators), IIIB (3 indicators) and IV (3 indicators).
  
  
  RESULTS
  708 patients were enrolled; 680 were eligible: 225 patients in stage I-II-IIIA; 156 patients in stage IIIB; 299 patients in stage IV. Cyto-histological diagnosis was available in 96%, 97%, 96% of stage I-II-IIIA, IIIB, IV respectively. Positron-emission tomography was performed in 64% of stage I-II-IIIA and 46% of stage IIIB. 88% of stage I-II patients eligible for surgery underwent lobectomy; after surgery, 61% of stage II and 57% of stage IIIA patients received adjuvant chemotherapy. Among stage IIIB patients who received combined chemo- radiotherapy, sequential approach was more common than concomitant treatment (86% vs. 14%). Among stage IV patients, 87% received platinum-based first-line treatment, and 70% received second-line.
  
  
  CONCLUSIONS
  The RIGHT-3 study showed that, in 2010, adherence to Italian NSCLC guidelines was high for many indicators (including those related to treatment of stage IV patients), but lower for some diagnostic procedures. Guidelines adherence monitoring can be useful to reduce variability in cancer care.
authors: Azienda Ospedaliera di Treviglio-Caravaggio, Piazzale Ospedale 1, 24047, Treviglio, Bergamo, Italy.
authors: Sandro
authors: S
authors: Barni
authors: IRCCS Casa Sollievo della Sofferenza, Via Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
authors: Evaristo
authors: E
authors: Maiello
authors: Dipartimento di Oncologia, Università di Torino, AOU San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Torino, Italy. Electronic address: massimo.dimaio@unito.it.
authors: Massimo
authors: M
authors: Di Maio
authors: Policlinico S Orsola-Malpighi, Via Albertoni 15,40138 Bologna, Italy.
authors: Andrea
authors: A
authors: Ardizzoni
authors: Istituto Toscano Tumori, Viale Alfieri 36, 57100 Livorno, Italy.
authors: Federico
authors: F
authors: Cappuzzo
authors: Azienda Ospedaliera Santa Maria di Terni, Via Tristano di Joannuccio 1, 05100 Terni, Italy.
authors: Ernesto
authors: E
authors: Maranzano
authors: Dipartimento di Oncologia, Università di Torino, AOU San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Torino, Italy.
authors: Silvia
authors: S
authors: Novello
authors: Azienda Ospedaliera di Perugia, Via S. Andrea Delle Fratte, 06156 Perugia, Italy.
authors: Chiara
authors: C
authors: Bennati
authors: MediData srl, Viale Virgilio 54/U, 41123 Modena, Italy.
authors: Alessandra
authors: A
authors: Ori
authors: MediData srl, Viale Virgilio 54/U, 41123 Modena, Italy.
authors: Sara
authors: S
authors: Rizzoli
authors: Azienda Ospedaliera di Perugia, Via S. Andrea Delle Fratte, 06156 Perugia, Italy.
authors: Lucio
authors: L
authors: Crinò
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy; D017024:Chemotherapy, Adjuvant / Q000379:methods; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007558:Italy; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000532:radiotherapy; D008297:Male; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D010865:Pilot Projects; D049268:Positron-Emission Tomography / Q000379:methods; D012106:Research; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds
keywords: Diagnosis; Guidelines; Lung cancer; Treatment