Adherence to breast cancer guidelines is associated with better survival outcomes: a systematic review and meta-analysis of observational studies in EU countries

Background: Breast cancer (BC) clinical guidelines offer evidence-based recommendations to improve quality of healthcare for patients with or at risk of BC. Suboptimal adherence to recommendations has the potential to negatively affect population health. However, no study has systematically reviewed...

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Autores: Ricci-Cabello, Ignacio, Vasquez-Mejia, Adrian, Canelo-Aybar, Carlos, Nino de Guzman, Ena, Perez-Bracchiglione, Javier, Rabassa, Montserrat, Rigau, David, Sola, Ivan, Song, Yang, Neamtiu, Luciana, Parmelli, Elena, Saz-Parkinson, ZuleiKa, Alonso-Coello, Pablo
Tipo de recurso: artículo
Fecha de publicación:2020
País:España
Institución:Instituto de Salud Carlos III (ISCIII)
Repositorio:Repisalud
Idioma:inglés
OAI Identifier:oai:repisalud.isciii.es:20.500.12105/22864
Acceso en línea:https://hdl.handle.net/20.500.12105/22864
Access Level:acceso abierto
Palabra clave:Breast cancer
Clinical guidelines
Adherence
Survival
Systematic review
Guías de Práctica Clínica como Asunto
Humanos
Análisis de Supervivencia
Unión Europea
Femenino
Neoplasias de la Mama
Estudios Observacionales como Asunto
Adhesión a Directriz
Breast Neoplasms
European Union
Female
Humans
Survival Analysis
Observational Studies as Topic
Guideline Adherence
Practice Guidelines as Topic
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spelling Adherence to breast cancer guidelines is associated with better survival outcomes: a systematic review and meta-analysis of observational studies in EU countriesRicci-Cabello, IgnacioVasquez-Mejia, AdrianCanelo-Aybar, CarlosNino de Guzman, EnaPerez-Bracchiglione, JavierRabassa, MontserratRigau, DavidSola, IvanSong, YangNeamtiu, LucianaParmelli, ElenaSaz-Parkinson, ZuleiKaAlonso-Coello, PabloBreast cancerClinical guidelinesAdherenceSurvivalSystematic reviewGuías de Práctica Clínica como AsuntoHumanosAnálisis de SupervivenciaUnión EuropeaFemeninoNeoplasias de la MamaEstudios Observacionales como AsuntoAdhesión a DirectrizBreast NeoplasmsEuropean UnionFemaleHumansSurvival AnalysisObservational Studies as TopicGuideline AdherencePractice Guidelines as TopicBackground: Breast cancer (BC) clinical guidelines offer evidence-based recommendations to improve quality of healthcare for patients with or at risk of BC. Suboptimal adherence to recommendations has the potential to negatively affect population health. However, no study has systematically reviewed the impact of BC guideline adherence -as prognosis factor- on BC healthcare processes and health outcomes. The objectives are to analyse the impact of guideline adherence on health outcomes and on healthcare costs.MethodsWe searched systematic reviews and primary studies in MEDLINE and Embase, conducted in European Union (EU) countries (inception to May 2019). Eligibility assessment, data extraction, and risk of bias assessment were conducted by one author and crosschecked by a second. We used random-effects meta-analyses to examine the impact of guideline adherence on overall survival and disease-free survival, and assessed certainty of evidence using GRADE. Results: We included 21 primary studies. Most were published during the last decade (90%), followed a retrospective cohort design (86%), focused on treatment guideline adherence (95%), and were at low (80%) or moderate (20%) risk of bias. Nineteen studies (95%) examined the impact of guideline adherence on health outcomes, while two (10%) on healthcare cost. Adherence to guidelines was associated with increased overall survival (HR=0.67, 95%CI 0.59-0.76) and disease-free survival (HR=0.35, 95%CI 0.15-0.82), representing 138 more survivors (96 more to 178 more) and 336 patients free of recurrence (73 more to 491 more) for every 1000 women receiving adherent CG treatment compared to those receiving non-adherent treatment at 5years follow-up (moderate certainty). Adherence to treatment guidelines was associated with higher costs, but adherence to follow-up guidelines was associated with lower costs (low certainty).Conclusions: Our review of EU studies suggests that there is moderate certainty that adherence to BC guidelines is associated with an improved survival. BC guidelines should be rigorously implemented in the clinical setting. Trial registration: PROSPERO (CRD42018092884).BioMed Central (BMC)20242024-09-1320202020-10-0720202020-10-07review articlehttp://purl.org/coar/resource_type/c_dcae04bcinfo:eu-repo/semantics/articlehttps://hdl.handle.net/20.500.12105/22864reponame:Repisaludinstname:Instituto de Salud Carlos III (ISCIII)Inglésengopen accesshttp://purl.org/coar/access_right/c_abf2Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:repisalud.isciii.es:20.500.12105/228642026-06-12T12:43:37Z
dc.title.none.fl_str_mv Adherence to breast cancer guidelines is associated with better survival outcomes: a systematic review and meta-analysis of observational studies in EU countries
title Adherence to breast cancer guidelines is associated with better survival outcomes: a systematic review and meta-analysis of observational studies in EU countries
spellingShingle Adherence to breast cancer guidelines is associated with better survival outcomes: a systematic review and meta-analysis of observational studies in EU countries
Ricci-Cabello, Ignacio
Breast cancer
Clinical guidelines
Adherence
Survival
Systematic review
Guías de Práctica Clínica como Asunto
Humanos
Análisis de Supervivencia
Unión Europea
Femenino
Neoplasias de la Mama
Estudios Observacionales como Asunto
Adhesión a Directriz
Breast Neoplasms
European Union
Female
Humans
Survival Analysis
Observational Studies as Topic
Guideline Adherence
Practice Guidelines as Topic
title_short Adherence to breast cancer guidelines is associated with better survival outcomes: a systematic review and meta-analysis of observational studies in EU countries
title_full Adherence to breast cancer guidelines is associated with better survival outcomes: a systematic review and meta-analysis of observational studies in EU countries
title_fullStr Adherence to breast cancer guidelines is associated with better survival outcomes: a systematic review and meta-analysis of observational studies in EU countries
title_full_unstemmed Adherence to breast cancer guidelines is associated with better survival outcomes: a systematic review and meta-analysis of observational studies in EU countries
title_sort Adherence to breast cancer guidelines is associated with better survival outcomes: a systematic review and meta-analysis of observational studies in EU countries
dc.creator.none.fl_str_mv Ricci-Cabello, Ignacio
Vasquez-Mejia, Adrian
Canelo-Aybar, Carlos
Nino de Guzman, Ena
Perez-Bracchiglione, Javier
Rabassa, Montserrat
Rigau, David
Sola, Ivan
Song, Yang
Neamtiu, Luciana
Parmelli, Elena
Saz-Parkinson, ZuleiKa
Alonso-Coello, Pablo
author Ricci-Cabello, Ignacio
author_facet Ricci-Cabello, Ignacio
Vasquez-Mejia, Adrian
Canelo-Aybar, Carlos
Nino de Guzman, Ena
Perez-Bracchiglione, Javier
Rabassa, Montserrat
Rigau, David
Sola, Ivan
Song, Yang
Neamtiu, Luciana
Parmelli, Elena
Saz-Parkinson, ZuleiKa
Alonso-Coello, Pablo
author_role author
author2 Vasquez-Mejia, Adrian
Canelo-Aybar, Carlos
Nino de Guzman, Ena
Perez-Bracchiglione, Javier
Rabassa, Montserrat
Rigau, David
Sola, Ivan
Song, Yang
Neamtiu, Luciana
Parmelli, Elena
Saz-Parkinson, ZuleiKa
Alonso-Coello, Pablo
author2_role author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv
dc.subject.none.fl_str_mv Breast cancer
Clinical guidelines
Adherence
Survival
Systematic review
Guías de Práctica Clínica como Asunto
Humanos
Análisis de Supervivencia
Unión Europea
Femenino
Neoplasias de la Mama
Estudios Observacionales como Asunto
Adhesión a Directriz
Breast Neoplasms
European Union
Female
Humans
Survival Analysis
Observational Studies as Topic
Guideline Adherence
Practice Guidelines as Topic
topic Breast cancer
Clinical guidelines
Adherence
Survival
Systematic review
Guías de Práctica Clínica como Asunto
Humanos
Análisis de Supervivencia
Unión Europea
Femenino
Neoplasias de la Mama
Estudios Observacionales como Asunto
Adhesión a Directriz
Breast Neoplasms
European Union
Female
Humans
Survival Analysis
Observational Studies as Topic
Guideline Adherence
Practice Guidelines as Topic
description Background: Breast cancer (BC) clinical guidelines offer evidence-based recommendations to improve quality of healthcare for patients with or at risk of BC. Suboptimal adherence to recommendations has the potential to negatively affect population health. However, no study has systematically reviewed the impact of BC guideline adherence -as prognosis factor- on BC healthcare processes and health outcomes. The objectives are to analyse the impact of guideline adherence on health outcomes and on healthcare costs.MethodsWe searched systematic reviews and primary studies in MEDLINE and Embase, conducted in European Union (EU) countries (inception to May 2019). Eligibility assessment, data extraction, and risk of bias assessment were conducted by one author and crosschecked by a second. We used random-effects meta-analyses to examine the impact of guideline adherence on overall survival and disease-free survival, and assessed certainty of evidence using GRADE. Results: We included 21 primary studies. Most were published during the last decade (90%), followed a retrospective cohort design (86%), focused on treatment guideline adherence (95%), and were at low (80%) or moderate (20%) risk of bias. Nineteen studies (95%) examined the impact of guideline adherence on health outcomes, while two (10%) on healthcare cost. Adherence to guidelines was associated with increased overall survival (HR=0.67, 95%CI 0.59-0.76) and disease-free survival (HR=0.35, 95%CI 0.15-0.82), representing 138 more survivors (96 more to 178 more) and 336 patients free of recurrence (73 more to 491 more) for every 1000 women receiving adherent CG treatment compared to those receiving non-adherent treatment at 5years follow-up (moderate certainty). Adherence to treatment guidelines was associated with higher costs, but adherence to follow-up guidelines was associated with lower costs (low certainty).Conclusions: Our review of EU studies suggests that there is moderate certainty that adherence to BC guidelines is associated with an improved survival. BC guidelines should be rigorously implemented in the clinical setting. Trial registration: PROSPERO (CRD42018092884).
publishDate 2020
dc.date.none.fl_str_mv 2020
2020-10-07
2020
2020-10-07
2024
2024-09-13
dc.type.none.fl_str_mv review article
http://purl.org/coar/resource_type/c_dcae04bc
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/20.500.12105/22864
url https://hdl.handle.net/20.500.12105/22864
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv BioMed Central (BMC)
publisher.none.fl_str_mv BioMed Central (BMC)
dc.source.none.fl_str_mv reponame:Repisalud
instname:Instituto de Salud Carlos III (ISCIII)
instname_str Instituto de Salud Carlos III (ISCIII)
reponame_str Repisalud
collection Repisalud
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812429

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