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.



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