gms | German Medical Science

MAINZ//2011: 56. GMDS-Jahrestagung und 6. DGEpi-Jahrestagung

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V.
Deutsche Gesellschaft für Epidemiologie e. V.

26. - 29.09.2011 in Mainz

Evaluation of the implementation of the national S3 guideline “Diagnosis, therapy and aftercare for breast cancer in women” and its influence on population-based outcome in different regions of Germany

Meeting Abstract

  • S. Schrodi - Munich Cancer Registry (MCR) of the Munich Cancer Centre (MCC) at the Department of medical Informatics, Biometry and Epidemiology, München
  • A. Tillack - Cancer Center, Brandenburg
  • A. Naas - Cancer Center, Brandenburg
  • A. Niedostate - Regional Clinical Cancer Register (RKKRD), Dresden
  • C. Werner - Regional Clinical Cancer Register (RKKRD), Dresden
  • B. Hollezek - Saarland Cancer Registry, Saarbrücken
  • C. Stegmaier - Saarland Cancer Registry, Saarbrücken
  • G. Schubert-Fritschle - Munich Cancer Registry (MCR) of the Munich Cancer Centre (MCC) at the Department of medical Informatics, Biometry and Epidemiology, München
  • J. Engel - Munich Cancer Registry (MCR) of the Munich Cancer Centre (MCC) at the Department of medical Informatics, Biometry and Epidemiology, München

Mainz//2011. 56. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 6. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi). Mainz, 26.-29.09.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11gmds603

DOI: 10.3205/11gmds603, URN: urn:nbn:de:0183-11gmds6030

Published: September 20, 2011

© 2011 Schrodi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Purpose: In 2004 the first national S3 guideline for the diagnosis, therapy and aftercare of breast cancer patients in Germany was implemented, and in 2008 the first update was released. The purpose of this study was to evaluate guideline adherence and possible influences on the quality of outcome in four different regions of Germany.

Methods: To date, data from 53,637 cases of primary operated breast cancer, diagnosed between 1999 and 2008 and registered in cancer registries from the regions of Brandenburg (B.:n=14,593), Dresden (D.:n=7,419), Munich (M.:n=26,181) and Saarland (S.:n=5,444) were analysed. Guideline adherence was examined initially by means of annual percentages of quality indicators and subsequently with multiple logistic models. For the interpretation of outcome quality, cox regression models were additionally calculated.

Results: Concerning primary operation of breast cancer, quality care procedures (such as breast conserving surgery (BCS) and sentinel lymph node biopsy (SLNB)) were already conducted in all four regions before the implementation of the S3 guidelines, although regional differences in the frequency and speed of realization were observed. Regarding the time trend and different distribution of prognostic factors, patients with small tumors (pT1/2) had a 2.2-fold higher chance for BCS in the western regions (Munich and Saarland) compared to the eastern regions (Brandenburg and Dresden). The western regions were quicker to implement guideline specific procedures. Since 2003, SLNB is known to be effective for the definition of nodal status, but German guideline didn't recommend it for clinical routine until 2008. Nevertheless, SLNB-rates in all regions rose rapidly since 2003, in the western regions faster than in the eastern regions. The chance of SLNB for the definition of the nodal status is 3.3-fold higher in the west than in the east. Possible reasons for the regional difference may be due to infrastructural aspects (e.g. less radiotherapy units in eastern regions) or a different cultural mentality concering operational techniques (e.g. more conservative therapy in eastern regions). Differences in procedural quality had no impact on the quality of outcome. The better univariate 10-year-overall-survival in Munich (B.:63.7%, D.:60.8%, M.:74.6%, S.:65.1%) can be largely described by different distributions of prognostic factors as a consequence of different screening activities.

Conclusion: Concerning local breast cancer operation and definition of nodal status, guideline recommendations were already in practice in all four German regions before the publication of the corresponding guideline. The East-West-Difference in the proportions and the speed of realisation of new treatment techniques has no impact on survival probability. Further analysis on different process- and outcome-quality parameters is underway.