Assessment of management practices for women with early-stage breast cancer
Assessment of management practices for women with early-stage breast cancer
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DOI：
10.1016/j.lpm.2007.03.046
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发表时间：
2007-12-01
期刊：
影响因子：
2.7
通讯作者：
Weill, Gilbert
中科院分区：
文献类型：
--
作者：
Fritsch, Beatrice;Ostermann, Michele;Weill, Gilbert
目的为改善乳腺癌患者的管理，为医护人员提供一种讨论工具，其依据是与国家指南相比，评估他们在当地的做法。方法回顾调查评估2002年第二季度在斯特拉斯堡任何一家医院接受乳腺导管癌(最大直径和2厘米)手术的所有患者的医疗档案。病例是从中央医疗数据库(PMSI)确定的。结果在2002年4月1日至6月30日期间，共有154名女性被转诊至8家医院的19名外科医生(公立3名，私立5名)。在此期间，每位外科医生的手术次数从1次到33次不等。仅有26%的病例在放射学诊断后的推荐时间内(即4周)进行了手术。14%的患者没有术前诊断分期，36%的患者在多学科团队会议上没有进行初步讨论。在36%的标准腋窝淋巴结清扫术中，清扫的淋巴结不到10个。42%的微钙化受试者没有提及术中X光检查。在来自15位经验丰富的病理学家的组织学报告中，44%没有报告pTNM状态，13%的手术切缘没有记录，54%的报告遗漏了关于血管侵犯的信息。最后，30%的患者接受了低于推荐剂量的放射治疗。结论：不同医院之间的重要差异表明有几个流程需要改进。外科医生和病理学家之间更好的协调是至关重要的。这项调查的结果指出了外部评估过程对提高专业人员的敏感度和改善乳腺癌患者的整体管理的价值。
Objective > To improve management of patients with breast cancer by providing healthcare professionals with a discussion tool based on on assessment of their local practices compared with national guidelines.Method > Retrospective survey assessing the medical files of all patients who hod surgery for ductal carcinoma of the breast (maximum diameter < 2 cm) in any Strasbourg hospital during the second quarter of 2002. Cases were identified from the central medical database (PMSI). Procedures were compared with national guidelines and results discussed with the healthcare professionals involved.Results > In all, 154 women were referred to 19 surgeons at 8 hospitals (public: 3; private: 5) between April 1 and june 30, 2002. The number of procedures per surgeon during this period ranged from 1 to 33. Surgery occurred within the recommended time from radiologic diagnosis (i.e. < 4 weeks) in only 26% of cases. There was no preoperative diagnostic staging for 14%, and no preliminary discussion at multidisciplinary team meetings for 36%. In 36% of standard axillary lymph node dissections, fewer than 10 lymph nodes were cleared. Intraoperative radiography was not mentioned for 42% of subjects with microcalcifications. The pTNM status was not reported in 44% of histology reports from 15 experienced pathologists, surgical margins were not documented in 13%, and information on vascular invasion was missing from 54%. Finally 30% of patients received lower doses of radiation therapy than recommended.Conclusion > Important differences between hospitals showed the need for improvement of several processes. Better coordination between surgeons and pathologists is essential. The results of this survey point out the value of external evaluation processes to sensitize professionals and improve the overall management of patients with breast cancer.