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Guideline adherence in bone-targeted treatment of cancer patients with bone metastases in Germany.

德国癌症骨转移患者骨靶向治疗的指南依从性。

  • 影响因子:2.83
  • DOI:10.1007/s00520-019-05018-2
  • 作者列表:"Link H","Diel I","Ohlmann CH","Holtmann L","Kerkmann M","Associations Supportive Care in Oncology (AGSMO), Medical Oncology (AIO), Urological Oncology (AUO), within the German Cancer Society (DKG) and the German Osteooncological Society (DOG).
  • 发表时间:2020-05-01
Abstract

PURPOSE:To assess adherence to the current European Society for Medical Oncology (ESMO) clinical practice guideline on bone health in cancer patients and the German guidelines for lung, breast, and prostate cancer among German oncologists in hospitals and office-based physicians and to identify predictors of guideline compliance to assess the needs for dedicated training. METHODS:This was a retrospective sample analysis representing hospitals and office-based physicians in Germany in 2016. Records from lung, breast, and prostate cancer patients who had received a diagnosis of bone metastasis between April 1, 2015, and March 31, 2016, were included. Oncologists at participating centers answered a self-assessment survey on aspects related to their professional life, including guideline adherence and years of clinical experience in medical oncology. Guideline adherence rates were assessed from patient records. Treatment variables and survey data were used to identify predictors of guideline compliance in a Classification and Regression Tree (CART) analysis. RESULTS:Disregarding recommendations for supplementation of calcium and vitamin D, guideline adherence among physicians treating lung, breast, or prostate cancer patients was 62%, 92%, and 83%, respectively. Compliance was 15%, 42%, and 40% if recommendations for dietary supplements were taken into account. Identified predictors of guideline compliance included treatment setting, medical specialty, years of professional experience, and frequency of quality circle attendance. CONCLUSIONS:Compliance with the ESMO and the German guidelines in cancer patients varies between medical specialties. In particular, patients with lung cancer and bone metastases often do not receive the recommended osteoprotective treatment and required supplementation. Discrepancies between guideline recommendations and common practice should be addressed with dedicated training.

摘要

目的: 评估目前欧洲医学肿瘤学会 (ESMO) 癌症患者骨健康临床实践指南和德国肺、乳腺指南的依从性,和前列腺癌在医院和办公室医生中的德国肿瘤学家,并确定指南依从性的预测因子,以评估专门培训的需求。 方法: 这是 2016 年德国医院和办公室医生的回顾性样本分析。纳入 2015 年 4 月 1 日至 20 16 年 3 月 31 日期间接受骨转移诊断的肺癌、乳腺癌和前列腺癌患者的记录。参与中心的肿瘤学家回答了一项关于其职业生活相关方面的自我评估调查,包括指南依从性和医学肿瘤学多年的临床经验。从患者记录中评估指南依从率。使用治疗变量和调查数据在分类和回归树 (CART) 分析中确定指南依从性的预测因子。 结果: 忽略钙和维生素d的补充建议,医生治疗肺癌、乳腺癌或前列腺癌患者的指南依从性分别为 62% 、 92% 和 83%。如果考虑膳食补充剂的建议,依从性为 15% 、 42% 和 40%。确定的指南依从性预测因素包括治疗设置、医学专业、专业经验年、质量圈出勤频率。 结论: 癌症患者对ESMO和德国指南的依从性因医学专业而异。尤其是肺癌骨转移患者,往往得不到推荐的骨保护治疗,需要补充。指南建议和常规做法之间的差异应通过专门培训来解决。

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DOI:10.1259/bjr.20180883
作者列表:["Tran S","Puric E","Walser M","Poel R","Datta NR","Heuberger J","Pica A","Marder D","Lomax N","Bolsi A","Morach P","Bachtiary B","Seddon BM","Schneider R","Bodis S","Weber DC"]

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影响因子:1.41
发表时间:2020-03-01
DOI:10.1177/1078155219842277
作者列表:["Gyori DJ","Bullington SM","Crawford BS","Vernon VP"]

METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.

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影响因子:2.83
发表时间:2020-01-01
DOI:10.1007/s00520-019-04843-9
作者列表:["Dohzono S","Sasaoka R","Takamatsu K","Hoshino M","Nakamura H"]

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骨肿瘤方向

骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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