Development and Measurement of Guideline-Based Indicators for Patients With Non-Hodgkin's Lymphoma

Wennekes, Lianne; Ottevanger, Petronella B.; Raemaekers, John; Schouten, Harry C.; Kok, Marjorie W. E. de; Punt, Cornelis J. A.; Grol, Richard; Wollersheim, Hub; Hermens, Rosella

doi:10.1200/jco.2010.30.1622

Cited by 33 publications

(51 citation statements)

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“…An analysis from the National Lymphocare Study exploring the patterns of use and the effectiveness of different treatment modalities in FL [1,19] revealed that one third of stage I FL patients were treated with radiotherapy alone, similar to other retrospective studies [16,18], and to our study. This lack of compliance with the guidelines could be due to patient and tumor related factors, making the adherence to guidelines low compared to other malignancies [19,25]. In the present study, the use of systemic therapy was more frequent in patients with adverse prognostic factors, such as an intermediate or high FLIPI score, or in those with more disseminated disease and high grade histology, a feature also observed in the subgroup of patients diagnosed with stage I FL.…”

Section: Discussioncontrasting

confidence: 44%

The long term follow-up of early stage follicular lymphoma treated with radiotherapy, chemotherapy or combined modality treatment

et al. 2015

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Section: Discussioncontrasting

confidence: 44%

The long term follow-up of early stage follicular lymphoma treated with radiotherapy, chemotherapy or combined modality treatment

et al. 2015

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“…A recent analysis of guideline adherence in patients from the Netherlands with lymphoma suggested that both patient-and tumor-related factors impede adherence to guidelines, and the need to improve care guidelines in lymphoma is higher than for several other tumor types. 7 A comprehensive approach that targets the physician, team members, hospitals, and care environment is required to improve guideline adherence. 8 However, our data question whether XRT, which is the historical standard, is the best choice and whether it has any impact on outcomes in this group of patients compared with other treatment modalities, including observation.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of First-Line Management Strategies for Stage I Follicular Lymphoma: Analysis of the National LymphoCare Study

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et al. 2012

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PurposeThe optimal management of stage I follicular lymphoma, according to consensus guidelines, is based on uncontrolled experiences of select institutions. Diverse treatment approaches are used despite guidelines that recommend radiation therapy (XRT).Patients and MethodsWe analyzed outcomes of patients with stage I follicular lymphoma enrolled onto the National LymphoCare database.ResultsOf 471 patients with stage I follicular lymphoma, 206 patients underwent rigorous staging as defined by both a bone marrow aspirate and biopsy and an imaging study (a computed tomography [CT] scan of the whole body, a positron emission tomography [PET]/CT scan, or both). Rigorously staged patients had superior progression-free survival (PFS) compared with nonrigorously staged patients (hazard ratio [HR], 0.63). Treatments given to rigorously staged patients were rituximab/chemotherapy (R-chemo; 28%), XRT (27%), observation (17%), systemic therapy + XRT (13%), rituximab monotherapy (12%), and other (3%). With a median follow-up of 57 months for PFS, there were 44 progression events (in 21% of patients) for rigorously staged patients. For these patients, PFS was significantly improved with either R-chemo or systemic therapy + XRT compared with patients receiving XRT alone after adjustment for histology, LDH, and the presence of B symptoms. There were no differences in overall survival.ConclusionIn this largest, prospectively enrolled group of patients with stage I follicular lymphoma, variable treatment approaches resulted in similar excellent outcomes, which challenges the paradigm that XRT should be standard for this presentation.

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“…However, active implementation is needed to increase adherence as publication and dissemination is not sufficient [9]. In France, as in other European countries, a national cancer plan has been implemented and adherence is promoted as an important step to enhancing quality of cancer care [10].…”

Section: Introductionmentioning

confidence: 99%

Quality indicators for colorectal cancer surgery and care according to patient-, tumor-, and hospital-related factors

et al. 2012

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BackgroundColorectal cancer (CRC) care has improved considerably, particularly since the implementation of a quality of care program centered on national evidence-based guidelines. Formal quality assessment is however still needed. The aim of this research was to identify factors associated with practice variation in CRC patient care.MethodsCRC patients identified from all cancer centers in South-West France were included. We investigated variations in practices (from diagnosis to surgery), and compliance with recommended guidelines for colon and rectal cancer. We identified factors associated with three colon cancer practice variations potentially linked to better survival: examination of ≥12 lymph nodes (LN), non-use and use of adjuvant chemotherapy for stage II and stage III patients, respectively.ResultsWe included 1,206 patients, 825 (68%) with colon and 381 (32%) with rectal cancer, from 53 hospitals. Compliance was high for resection, pathology report, LN examination, and chemotherapy use for stage III patients. In colon cancer, 26% of stage II patients received adjuvant chemotherapy and 71% of stage III patients. 84% of stage US T3T4 rectal cancer patients received pre-operative radiotherapy. In colon cancer, factors associated with examination of ≥12 LNs were: lower ECOG score, advanced stage and larger hospital volume; factors negatively associated were: left sided tumor location and one hospital district. Use of chemotherapy in stage II patients was associated with younger age, advanced stage, emergency setting and care structure (private and location); whereas under-use in stage III patients was associated with advanced age, presence of comorbidities and private hospitals.ConclusionsAlthough some changes in practices may have occurred since this observational study, these findings represent the most recent report on practices in CRC in this region, and offer a useful methodological approach for assessing quality of care. Guideline compliance was high, although some organizational factors such as hospital size or location influence practice variation. These factors should be the focus of any future guideline implementation.

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Development and Measurement of Guideline-Based Indicators for Patients With Non-Hodgkin's Lymphoma

Abstract: In the Netherlands, almost all indicators for NHL needed improvement. This should be evaluated in other countries as well. International efforts should be undertaken to improve the quality of care of this often curable malignancy.

Cited by 33 publications

References 30 publications

The long term follow-up of early stage follicular lymphoma treated with radiotherapy, chemotherapy or combined modality treatment

The long term follow-up of early stage follicular lymphoma treated with radiotherapy, chemotherapy or combined modality treatment

Effectiveness of First-Line Management Strategies for Stage I Follicular Lymphoma: Analysis of the National LymphoCare Study

Quality indicators for colorectal cancer surgery and care according to patient-, tumor-, and hospital-related factors

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