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Breast Cancer Research and Treatment

, Volume 152, Issue 2, pp 357–366 | Cite as

Guidelines are advantageous, though not essential for improved survival among breast cancer patients

  • Regine Wolters
  • Jörg Wischhusen
  • Tanja Stüber
  • Claire Rachel Weiss
  • Mathias Krockberger
  • Catharina Bartmann
  • Maria Blettner
  • Wolfgang Janni
  • Rolf Kreienberg
  • Lukas Schwentner
  • Igor Novopashenny
  • Manfred Wischnewsky
  • Achim Wöckel
  • Joachim Diessner
Clinical trial

Abstract

The purpose of this retrospective multicenter study was to resolve the pseudo-paradox that the clinical outcome of women affected by breast cancer has improved during the last 20 years irrespective of whether they were treated in accordance with clinical guidelines or not. This retrospective German multicenter study included 9061 patients with primary breast cancer recruited from 1991 to 2009. We formed subgroups for the time intervals 1991–2000 (TI1) and 2001–2009 (TI2). In these subgroups, the risk of recurrence (RFS) and overall survival (OS) were compared between patients whose treatment was either 100 % guideline-conforming or, respectively, non-guideline-conforming. The clinical outcome of all patients significantly improved in TI2 compared to TI1 [RFS: p < 0.001, HR = 0.57, 95 % CI (0.49–0.67); OS: p < 0.001, HR = 0.76, 95 % (CI 0.66–0.87)]. OS and RFS of guideline non-adherent patients also improved in TI2 compared to TI. Comparing risk profiles, determined by Nottingham Prognostic Score reveals a significant (p = 0.001) enhancement in the time cohort TI2. Furthermore, the percentage of guideline-conforming systemic therapy (endocrine therapy and chemotherapy) significantly increased (p < 0.001) in the time cohort TI2 to TI for the non-adherent group. The general improvement of clinical outcome of patients during the last 20 years is also valid in the subgroup of women who received treatments, which deviated from the guidelines. The shift in risk profiles as well as medical advances are major reasons for this improvement. Nevertheless, patients with 100 % guideline-conforming therapy always had a better outcome compared to patients with guideline non-adherent therapy.

Keywords

Breast cancer Clinical guidelines Guideline adherence Paradox BRENDA 

Notes

Acknowledgments

We gratefully thank the following people for their contributions to the BRENDA study: Karsten Gnauert (Ostalbklinikum, Aalen), Steffen Fritz (Kreisklinik Biberach), Ulf Göretzlehner (Kreiskrankenhaus Ehingen), Hans-Walter Vollert (Städt. Krankenhaus Friedrichshafen), Peter Jakob Albert (Klinikum Heidenheim), Ricardo Felberbaum (Klinikum Kempten), Andreas Zorr (Klinikum Konstanz), Felix Flock (Klinikum Memmingen), Erik Schlicht (Stauferklinik, Mutlangen), Martina Gropp-Meier (Oberschwabenklinik Ravensburg), Gerhard Bartzke (Kreiskrankenhaus Rottweil), Andreas Rempen (Diakonie-Krankenhaus, Schwäbisch Hall), Edgar Schelble (Kreiskrankenhaus Sigmaringen), Theodor Dinkelacker (Helfenstein-Klinik Geislingen), Andreas Grüneberger (Oberschwabenklinik Wangen), and Thorsten Kühn (Städt. Kliniken, Esslingen). This work was supported by the German Federal Ministry of Education and Research (BMBF-Grant-01ZP0505).

Compliance with Ethical Standards

Conflict of interest

All authors declare that there are no potential conflicts of interest, including any financial, personal, or other relationships with other people or organizations that could inappropriately influence this work.

Ethical approval

For this retrospective study, formal consent is not required. This study and the BRENDA project have been approved by the Ethics Committee of the University of Ulm, which covers all participating breast cancer centers of the BRENDA network.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Regine Wolters
    • 3
  • Jörg Wischhusen
    • 1
  • Tanja Stüber
    • 1
  • Claire Rachel Weiss
    • 1
  • Mathias Krockberger
    • 1
  • Catharina Bartmann
    • 1
  • Maria Blettner
    • 4
  • Wolfgang Janni
    • 2
  • Rolf Kreienberg
    • 2
  • Lukas Schwentner
    • 2
  • Igor Novopashenny
    • 3
  • Manfred Wischnewsky
    • 3
  • Achim Wöckel
    • 1
  • Joachim Diessner
    • 1
  1. 1.Department for Obstetrics and GynecologyUniversity of Würzburg Medical SchoolWürzburgGermany
  2. 2.Department for Obstetrics and GynecologyUniversity of Ulm Medical SchoolUlmGermany
  3. 3.Faculty of Mathematics and Computer ScienceUniversity of BremenBremenGermany
  4. 4.Institut für Medizinische Biometrie, Epidemiologie und Informatik (IMBEI)University of MainzMainzGermany

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