PDF(Sci-hub)
Abstract：
OBJECTIVE: There is a lack of real-world studies evaluating the impact on survival of an evidence-based pathway of care in breast cancer. The aim of this work is to investigate the effect of adherence to guidelines on long-term survival for a cohort of Italian breast cancer patients.
METHODS: The cohort included incident female breast cancer cases (2007-12), from the registry of the Milan province (Italy), not metastatic at diagnosis and receiving primary surgery. We selected sets of indicators, according to patient and tumor characteristics. We then defined the pathway of care as adherent to guidelines if it fulfilled at least 80% of the indicators. Indicators were measured using different administrative health databases linked on a unique key. A causal inference approach was used, drawing a directed acyclic graph and fitting an inverse probability weighted marginal structural model, accounting for patient\'s demographic, socioeconomic and tumor characteristics.
RESULTS: The analysis included 6333 patients, 69% of them were classified as having an adherent care. Mean age was 61 years (standard deviation, 13.6 years) and half of the patients were in Stage I (50%) at diagnosis. Median follow-up time was 5.6 years. Overall, 5-year survival was 90% (95% CI, 89-91%). The estimated risk of death was 30% lower for patients with adherent than nonadherent care (hazard ratio [HR], 0.66; 95% CI, 0.55-0.77).
CONCLUSIONS: Our study confirms, in real-world care, the impact on survival of receiving a care pathway adherent to guidelines in non-metastatic breast cancer patients.
METHODS: The cohort included incident female breast cancer cases (2007-12), from the registry of the Milan province (Italy), not metastatic at diagnosis and receiving primary surgery. We selected sets of indicators, according to patient and tumor characteristics. We then defined the pathway of care as adherent to guidelines if it fulfilled at least 80% of the indicators. Indicators were measured using different administrative health databases linked on a unique key. A causal inference approach was used, drawing a directed acyclic graph and fitting an inverse probability weighted marginal structural model, accounting for patient\'s demographic, socioeconomic and tumor characteristics.
RESULTS: The analysis included 6333 patients, 69% of them were classified as having an adherent care. Mean age was 61 years (standard deviation, 13.6 years) and half of the patients were in Stage I (50%) at diagnosis. Median follow-up time was 5.6 years. Overall, 5-year survival was 90% (95% CI, 89-91%). The estimated risk of death was 30% lower for patients with adherent than nonadherent care (hazard ratio [HR], 0.66; 95% CI, 0.55-0.77).
CONCLUSIONS: Our study confirms, in real-world care, the impact on survival of receiving a care pathway adherent to guidelines in non-metastatic breast cancer patients.
摘要：
目的：缺乏评估乳腺癌循证护理途径对生存的影响的真实世界研究。这项工作的目的是研究遵守指南对意大利乳腺癌患者队列长期生存的影响。
方法：该队列包括女性乳腺癌事件（2007-12），来自米兰省（意大利）的登记处，在诊断和接受初次手术时没有转移。我们选择了一组指标，根据患者和肿瘤的特点。然后，我们将护理途径定义为遵守指南，如果它满足至少80％的指标。使用在唯一密钥上链接的不同行政卫生数据库来衡量指标。使用了因果推断方法，绘制有向无环图并拟合逆概率加权边际结构模型，考虑患者的人口统计，社会经济和肿瘤特征。
结果：分析包括6333例患者，其中69％被归类为具有粘附性护理。平均年龄为61岁(标准差，13.6年），一半的患者在诊断时处于I期（50％）。中位随访时间为5.6年。总的来说,5年生存率为90％（95％CI，89-91％）。粘附治疗患者的估计死亡风险比非粘附治疗患者低30%(风险比[HR]，0.66；95%CI，0.55-0.77）。
结论：我们的研究证实，在现实世界中，非转移性乳腺癌患者接受遵循指南的护理途径对生存率的影响.
方法：该队列包括女性乳腺癌事件（2007-12），来自米兰省（意大利）的登记处，在诊断和接受初次手术时没有转移。我们选择了一组指标，根据患者和肿瘤的特点。然后，我们将护理途径定义为遵守指南，如果它满足至少80％的指标。使用在唯一密钥上链接的不同行政卫生数据库来衡量指标。使用了因果推断方法，绘制有向无环图并拟合逆概率加权边际结构模型，考虑患者的人口统计，社会经济和肿瘤特征。
结果：分析包括6333例患者，其中69％被归类为具有粘附性护理。平均年龄为61岁(标准差，13.6年），一半的患者在诊断时处于I期（50％）。中位随访时间为5.6年。总的来说,5年生存率为90％（95％CI，89-91％）。粘附治疗患者的估计死亡风险比非粘附治疗患者低30%(风险比[HR]，0.66；95%CI，0.55-0.77）。
结论：我们的研究证实，在现实世界中，非转移性乳腺癌患者接受遵循指南的护理途径对生存率的影响.
