Ensuring Quality Cancer Care

implementation affect success, and the most successful guidelines are those with internal development, specific educational interventions, patient-specific reminders at the time of consultation, and a system to hold providers accountable for adherence. Studies of the impact of oncology guidelines have often not included a concurrent control group that was not exposed to the guideline intervention, which makes it difficult to attribute change to guideline implementation.

TABLE 6.8

Compliance with National Guidelines in Italy as Measured by Chart Audit, 1987

Recommendation	Compliance (%)
Breast Cancer	Gold standard: 100%
Bilateral mammography	61
Clinical stage	37
Pathological stage	60
Evaluation of axillary lymph nodes	89
Avoidance of radical mastectomy if T < 2.0 cm	84
Radiotherapy after quadrantectomy	65
Adjuvant chemotherapy started at <4 weeks	52
Polychemotherapy if <50, + lymph nodes	71
Chemotherapy delivered at full dosage	86
Colon Cancer
CEA levels and liver ultrasound	40
TNM staging	78
Search for intra-abdominal metastasis	67
Information on resection borders	48
Evaluation of regional lymph nodes	66
Miles resection in lower rectal cancer	68
Radiotherapy in rectal and rectosigmoid cancer	11
No adjuvant chemotherapy in colon cancer	79
If chemotherapy, 5-FU-containing regimen	90
Ovarian Cancer
Full information on tumor grading	30
Staging including abdominal echography	75
Histologic type according to standard classifications	89
Chest x-ray	97
Evaluation of residual tumor	45
Disease stage according to standard classification	85
Alkylating agent as part of chemotherapy for early disease	18
Cisplatin-containing regimens for advanced disease	34
Monitoring of toxicity while on chemotherapy	91
Monitoring of nephrotoxicity while on chemotherapy	84
NOTE: CEA = carcinoembryonic antigen; 5-FU = 5-fluorouracil; TNM = tumor-node-mestastasis. SOURCE: Grilli et al., 1991.

Table of Contents

Front Matter R1-R10

Summary 1-12

1 Introduction 13-17

2 The Cancer Care 'System' 18-45

3 Ensuring Access to Cancer Care 46-78

4 Defining and Assessing Quality Cancer Care 79-115

5 Health Care Delivery and Quality of Cancer Care 116-143

6 Cancer Care Quality Assurance 144-179

7 Health Services Research in Cancer Care 180-210

8 Findings and Recommendations 211-225

Glossary 226-230

Acronyms 231-234

Index 235-246