Provision of breast cancer care and survival in Germany – results from a population-based high resolution study from Saarland

BMC Cancer

Bernd Holleczek¹  Hermann Brenner² 

[1] Saarland Cancer Registry, Präsident Baltz-Straße 5, 66119 Saarbrücken, Germany

[2] German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany

关键词: Germany;    Relative survival;    Population-based cancer registry;    Evaluation of cancer care;    Clinical Practice Guidelines;    Breast cancer;   

Others  :  1120983
DOI  :  10.1186/1471-2407-14-757

 received in 2014-02-11, accepted in 2014-09-24,  发布年份 2014

【 摘 要 】

Background

Studies on the implementation of Clinical Practice Guidelines (CPG) and particularly its effect on breast cancer (BRC) survival on a population-level are scant. This population-based high resolution study from Germany aims at providing data on the usage of BRC treatment, the extent of adherence to CPG and, as a novelty, survival of BRC patients according to major recommended treatment options.

Methods

Data from the Saarland Cancer Registry including women diagnosed with invasive BRC without distant metastasis and followed up between 2000 and 2009 were used. Provision of cancer care according to major treatment options is presented by age, clinical subtypes of BRC, and over time. Conventional and modeled period analysis was used to derive estimates of most up-to-date 5-year relative survival (RS) and the effect of non-adherence to CPG on relative excess risk of death (RER).

Results

The study revealed increasing guideline adherence, with high levels already seen for local treatment (e.g. 67% of the BRC patients in 2008/09 received breast conserving surgery), and substantial progress since the millennium change with regard to sentinel node dissection (SND) and adjuvant systemic treatments (e.g. SND and chemotherapy provided to 62% of all patients and 79% of the patients with nodal positive or hormone receptor negative BRC in 2008/09, respectively). It further demonstrated increased cancer related mortality among patients without guideline compliant cancer treatment (e.g. patients with nodal positive and hormone receptor negative BRC who were not treated with chemotherapy had a 5-year RS of 29% (RER: 2.89, 95% CI: 1.46–5.71) compared to 54% for patients obtaining chemotherapy).

Conclusions

This study provides data on the implementation of CPG in a highly developed European country and extends available population-based survival data of BRC patients and may provide evidence of increased cancer related excess mortality, if BRC patients do not receive guideline compatible treatment.

【 授权许可】

   
2014 Holleczek and Brenner; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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