Adherence to breast cancer guidelines is associated with better survival outcomes: A systematic review and meta-analysis of observational studies in EU countries
Por:
Ricci-Cabello I., Vásquez-Mejía A., Canelo-Aybar C., Niño De Guzman E., Pérez-Bracchiglione J., Rabassa M., Rigau D., Solà I., Song Y., Neamtiu L., Parmelli E., Saz-Parkinson Z., Alonso-Coello P.
Publicada:
1 ene 2020
Resumen:
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. Methods: We 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 5 years 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). © 2020 The Author(s).
Filiaciones:
Ricci-Cabello I.:
Balearic Islands Health Research Institute (IdISBa), Palma, Spain
CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Primary Care Research Unit of Mallorca, Balearic Islands Health Service, Palma, Spain
Vásquez-Mejía A.:
Facultad de Medicina Humana, Universidad Nacional Mayor de San Marcos, Lima, Peru
Canelo-Aybar C.:
CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, Barcelona, 08025, Spain
Niño De Guzman E.:
Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, Barcelona, 08025, Spain
Pérez-Bracchiglione J.:
Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Valparaíso, Chile
Rabassa M.:
Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, Barcelona, 08025, Spain
Rigau D.:
Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, Barcelona, 08025, Spain
Solà I.:
Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, Barcelona, 08025, Spain
CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Song Y.:
Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, Barcelona, 08025, Spain
Neamtiu L.:
European Commission, Joint Research Centre (JRC), Ispra, Italy
Parmelli E.:
European Commission, Joint Research Centre (JRC), Ispra, Italy
Saz-Parkinson Z.:
European Commission, Joint Research Centre (JRC), Ispra, Italy
Alonso-Coello P.:
Iberoamerican Cochrane Centre - Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Antonio María Claret 167, Barcelona, 08025, Spain
CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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