Baseline radiological staging in primary breast cancer: impact of educational interventions on adherence to published guidelines

McWhirter, Elaine; Yogendran, Geetha; Wright, Frances W.; Pharm, George Dranitsaris M.; Clemons, Mark

doi:10.1111/j.1365-2753.2007.00804.x

Cited by 20 publications

(34 citation statements)

References 18 publications

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“…22,24,25 Additional work is needed to identify reasons why guidelines pertaining to perioperative imaging are not being followed. The factors evaluated should include factors related to patients, 22 physicians 26 and funding agencies. 27 The strengths of the current study included use of a large cohort representing all women with primary operable breast cancer in Ontario.…”

Section: Discussionmentioning

confidence: 99%

Imaging for distant metastases in women with early-stage breast cancer: a population-based cohort study

Simos

Catley

Walraven

et al. 2015

CMAJ

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Interpretation: Despite recommendations from multiple international guidelines, most Ontario women with early-stage breast cancer underwent imaging to detect distant metastases. Inappropriate imaging in asymptomatic patients with early-stage disease is costly and may lead to harm. The use of population datasets will allow investigators to evaluate whether or not strategies to implement practice guidelines lead to meaningful and sustained change in physician practice. AbstractCMAJ Podcasts: editor's summary at soundcloud

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Section: Discussionmentioning

confidence: 99%

Imaging for distant metastases in women with early-stage breast cancer: a population-based cohort study

Simos

Catley

Walraven

et al. 2015

CMAJ

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“…Strategies aimed at patients 13,14 and physicians 10,15 should be implemented to promote adherence to practice guidelines. …”

Section: Discussionmentioning

confidence: 99%

Cost Implications of Unwarranted Imaging for Distant Metastasis in Women with Early-Stage Breast Cancer in Ontario

et al. 2016

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“…Of these articles, six articles were included and summarized for their use of staging investigations in early breast cancer (see Table 4). Five studies included investigations of chest X-ray, liver/ abdominal ultrasound, and bone scan [6,7,[9][10][11]. The study conducted by Morris et al [12] covered staging tests of abdominal ultrasound and bone scan.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Over staging can be costly in terms of hospital resources and time, leading to unwarranted investigations. It can also cause unnecessary psychological distress in patients and erroneous staging results can lead to further investigations [6,7].…”

Section: Introductionmentioning

confidence: 98%

Is knowledge translation adequate? A quality assurance study of staging investigations in early stage breast cancer patients

Han

Hogeveen

Goldstein

et al. 2011

Breast Cancer Res Treat

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After primary surgery, patients diagnosed with early stage breast cancer undergo radiological investigations based on pathologic stage of disease to rule out distant metastases. Published guidelines can aid clinicians in determining which tests are appropriate based on stage of disease. We wished to assess the consistency of radiological staging in an academic community oncology setting with standard guidelines and to determine the overall impact of non-adherence to these guidelines. A retrospective cohort study was conducted for new breast cancer patients seen at a single institution between January 2009 and April 2010. Patients were included if initial diagnosis and primary surgery was at this institution. Pathologic stage and radiological tests completed were recorded. A literature review was performed and the results were compared with those from this study to determine overall adherence rates. Subsequently, a cost analysis was performed to determine the financial impact at this centre. 231 patients met eligibility criteria for inclusion in this study. A large proportion of patients were over-staged with 129 patients (55%) undergoing unnecessary investigations according to guidelines. Specifically, 59% of stage I patients and 58% of stage II patients were over-investigated. Distant metastases at the time of diagnosis were found in three patients, all of whom had stage III disease (1.3%). The literature reviewed revealed similar non-adherence rates in other centres. The estimated cost of such non-adherence is in the range of $78 (CDN) per new early stage breast cancer patient seen at this centre. This oncology centre has a low adherence to practice guidelines for staging investigations in breast cancer patients, with 55% of patients undergoing unnecessary tests. Very few patients had metastases at diagnosis, and all had pathological stage III disease. Efforts may need to focus on improving knowledge translation across clinical oncology settings to increase guideline adherence.

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Baseline radiological staging in primary breast cancer: impact of educational interventions on adherence to published guidelines

Cited by 20 publications

References 18 publications

Imaging for distant metastases in women with early-stage breast cancer: a population-based cohort study

Imaging for distant metastases in women with early-stage breast cancer: a population-based cohort study

Cost Implications of Unwarranted Imaging for Distant Metastasis in Women with Early-Stage Breast Cancer in Ontario

Is knowledge translation adequate? A quality assurance study of staging investigations in early stage breast cancer patients

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