Influence of adherence with guideline-driven recommendations on survival in women operated for breast cancer: Real-life evidence from Italy
Giovanni Corrao,
Federico Rea,
Enza Di Felice,
Mirko Di Martino,
Marina Davoli,
Luca Merlino,
Flavia Carle,
Rossana De Palma
Affiliations
Giovanni Corrao
National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
Federico Rea
National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Corresponding author. Dipartimento di Statistica e Metodi Quantitativi, Università degli Studi di Milano-Bicocca, Via Bicocca degli Arcimboldi, 8, Edificio U7, 20126, Milano, Italy.
Enza Di Felice
Authority for Healthcare and Welfare, Emilia Romagna Regional Health Service, Bologna, Italy
Mirko Di Martino
Department of Epidemiology, Lazio Regional Health Service, Roma, Italy
Marina Davoli
Department of Epidemiology, Lazio Regional Health Service, Roma, Italy
Luca Merlino
National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Epidemiologic Observatory, Lombardy Region Welfare Department, Milan, Italy
Flavia Carle
National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
Rossana De Palma
Authority for Healthcare and Welfare, Emilia Romagna Regional Health Service, Bologna, Italy
Background: A set of indicators to assess the quality of care for women operated for breast cancer was developed by an expert working group of the Italian Health Ministry in order to compare the Italian regions. A study to validate these indicators through their relationship with survival was carried out. Methods: The 16,753 women who were residents in three Italian regions (Lombardy, Emilia-Romagna and Lazio) and hospitalized for breast cancer surgery during 2011 entered the cohort and were followed until 2016. Adherence to selected recommendations (i.e., surgery timeliness, medical therapy timeliness, appropriateness of complementary radiotherapy and mammographic follow-up) was assessed. Multivariable proportional hazards models were fitted to estimate hazard ratios for the association between adherence with recommendations and the risk of all-cause mortality. Results: Adherence to recommendations was 53% for medical therapy timeliness, 73% for appropriateness of mammographic follow-up, 74% for surgery timeliness and 82% for appropriateness of complementary radiotherapy. Risk reductions of 26%, 62% and 56% were observed for adherence to recommendations on medical therapy timeliness, appropriateness of complementary radiotherapy and mammographic follow-up, respectively. There was no evidence that mortality was affected by surgery timeliness. Conclusions: Clinical benefits are expected from improvements in adherence to the considered recommendations. Close control of women operated for breast cancer through medical care timeliness and appropriateness of radiotherapy and mammographic monitoring must be considered the cornerstone of national guidance, national audits, and quality improvement incentive schemes.
