Institutional validation of breast cancer treatment guidelines

Several groups have developed clinical guidelines for the management of bre ast cancer, yet little data exist regarding their validation. Therefore, we examined the effect of published National Comprehensive Cancer Network (NC CN) guidelines for invasive breast cancer on survival, quality of life (QOL ), and hospital cost. From 260 consecutive breast cancer patients, 129 pati ents were identified for analysis: 93 patients (72%) were treated according to the guidelines (NCCN+), while the treatment of 36 patients (28%), with a similar stage distribution, deviated from the guidelines (NCCN-). Patient s were excluded from analysis with a diagnosis of carcinoma in situ, inflam matory cancer, stage IV disease, and comorbid conditions that affected trea tment. The 5-year survival was 87.6% for the NCCN+ patients versus 83.3% fo r NCCN-patients (P = 0.319 by Kaplan-Meier). Twelve QOL parameters were eva luated using a Likert-type scale (1 = severe and 5 = none). NCCN+ patients had a cumulative QOL score of 4.18 +/- 0.08 versus 4.24 +/- 0.14 for NCCN- patients (P = 0.745). Treatment-related costs were $20,300 +/- 1800 for NCC N+ patients versus $59,700 +/- 25,200 for NCCN- patients (P = 0.016 by t te st). Although deviation from NCCN breast cancer guidelines had no effect on perceived quality of life or survival, there was a significant decrease in cost in the NCCN+ group. These findings suggest that adherence to NCCN gui delines can significantly reduce the cost of breast cancer care without adv ersely affecting either survival or quality of life. (C) 2001 Academic Pres s.