title: Assessing guideline adherence and patient outcomes in cervical cancer.
abstract: OBJECTIVE
  To investigate adherence to clinical practice guidelines (CPGs) in cervical cancer and the correlation with clinical outcomes.
  
  
  METHODS
  A retrospective analysis was conducted using patient information from a population-based cancer registry (2005-2011, n = 208). Compliance to 10 widely accepted CPGs was assessed. Univariate and multivariate analyses were performed to assess sociodemographic factors associated with CPG adherence. Multivariate Cox regression was performed to assess the relationship between CPG adherence and 5-year survival.
  
  
  RESULTS
  Adherence to individual CPGs ranged from 47% to 100%. Compliance to all applicable CPGs was seen in 54% (n = 72) of patients, 62% of stage I and II patients and 22% of stage III and IV patients. Poorest adherence was seen with those with locally advanced disease receiving chemoradiotherapy. Patients who lived within 5 km of the treatment facility were more likely to be compliant. No difference was found for either age, country of birth or socioeconomic status group. Five-year survival was greater for stage I and II patients who received guideline adherent care (93.7% vs 69.7%, P = 0.002), and they had a significant lower risk of death on multivariate analysis (HR = 0.22, P = 0.015). There was no significant difference for those with stage III or IV disease.
  
  
  CONCLUSIONS
  In this study, CPG adherence is variable between treatment modalities and only half complied to all applicable CPGs. There was better adherence in those with early-stage disease and this was associated with improved patient outcomes. CPG adherence may be a useful surrogate for quality of care.
authors.affiliation: Cancer Therapy Centre, Liverpool Hospital, NSW, Australia.|South Western Sydney Clinical School, University of New South Wales, NSW, Australia.
authors.forename: Kim-Lin
authors.initials: KL
authors.lastname: Chiew
authors.affiliation: South Western Sydney Clinical School, University of New South Wales, NSW, Australia.|Healthy People & Places Unit, South Western Sydney Local Health District, NSW, Australia.
authors.forename: Shanley
authors.initials: S
authors.lastname: Chong
authors.affiliation: Sydney and South West Sydney Clinical Cancer Registry, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
authors.forename: Kirsten J
authors.initials: KJ
authors.lastname: Duggan
authors.affiliation: Sydney and South West Sydney Clinical Cancer Registry, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
authors.forename: Nasreen
authors.initials: N
authors.lastname: Kaadan
authors.affiliation: Cancer Therapy Centre, Liverpool Hospital, NSW, Australia.|South Western Sydney Clinical School, University of New South Wales, NSW, Australia.|University of Western Sydney, NSW, Australia.
authors.forename: Shalini K
authors.initials: SK
authors.lastname: Vinod
mesh_terms: D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence; D006176:Gynecology / Q000379:methods / Q000592:standards; D006801:Humans; D008495:Medical Oncology / Q000379:methods / Q000592:standards; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000628:therapy*
keywords: cervix; radiation oncology; surgical oncology