Introduction: Treatment recommendations for cancer patients are more likely to be consistent with clinical practice guidelines (CPG) when discussed at multidisciplinary cancer team meetings (MDMs). Adherence to CPG and patient compliance with recommended treatment(s) (i.e., completion of treatment that was started) may affect patient survival.
Aim: (i) To examine adherence of (a) MDM treatment recommendations to CPG and (b) treatment to CPG and MDM recommendations for women with breast cancer. (ii) To assess the effect of guideline adherent treatment and patient compliance on survival.
Methods: This retrospective, single-centre study included women diagnosed with primary breast cancer between January 2006 and December 2009. MDM treatment recommendations and the treatment(s) received (surgery) or started (adjuvant therapies) were compared with hospital CPG to assess guideline adherence. Overall and recurrence-free survival was investigated using Kaplan-Meier analysis and multivariable Cox regression models.
Outcomes: The study included 1,028 patients (mean age 58 years). Most MDM recommendations were guideline-adherent (n=1,014, 98.6%). MDM recommendations were implemented for 922 (89.7%) patients and 929 (90.4%) patients received guideline-adherent treatment. Reasons for deviation from CPG included: patient preferences (n=81, 81.7%), physician decision (n=8, 8.0%), co-morbidities (n=7, 7.1%), and were not established for 3 patients. Treatment adherence with CPGs was associated with a 30% lower risk of death (95%CI:0.46-1.06) and a 52% lower risk of recurrence (95%CI:0.28-0.81) in initial unadjusted analysis. Patient compliance was associated with a 49% lower risk of death (95%CI:0.35-0.74) and 73% lower risk of recurrence (95%CI:0.17-0.44). However, further investigations revealed that patients who complied with treatment were more likely to have favourable tumour characteristics.
Conclusions: The majority of MDM recommendations were adherent to CPG and were implemented. Treatment adherence with CPG and patient compliance, both favourably predicted overall and recurrence-free survival.