Gion M, Cardinali G, Guzzinati S, Morandi P, Trevisiol C, Fabricio ASC, Rugge M, Zorzi M

Risk Management and Healthcare Policy 2022, 15:1087-1100


Purpose: Clinical practice guidelines (CPGs) recommend against intensive follow-up in asymptomatic women with breast cancer
(BC). The present study assessed the adherence to CPGs of diagnostic tests ordering during BC follow-up by exploring routinely
collected health data through an algorithm developed to distinguish patients according to their status at follow-up.
Patients and Methods: A retrospective population-based cohort study was performed monitoring the diagnostic tests ordered during
5 years of follow-up in all BC cases incident in 2013 in the Veneto Region, Italy. Data were extracted from the Veneto Tumour
Registry, the Hospital Discharge Records and the Outpatients’ Records of Diagnostic and Therapeutic Procedures. The algorithm was
developed using information on infusion of anticancer agents, imaging exams ordered, and death.
Results: The algorithm classified patients by status at follow-up in four groups: (i) probably no-evidence-of-disease (NED), (ii)
suspicious signs of relapse not confirmed, (iii) increased risk of relapse and (iv) advanced disease at presentation or progressive
disease. A total of 3930 consecutive incident cases were followed-up for 5 years, corresponding to 17,184 person-years, 15,345 of
which pertaining to NED cases. In NED cases, 32,900 tumour markers and 15,858 imaging exams were ordered. Liver ultrasonography
and chest radiography were most frequently ordered.
Conclusion: In contrast with recommendations of CPGs, a substantial overordering of tumour markers and imaging exams occurred
in NED BC patients. The developed algorithm can be repeatedly applied to routine health datasets for regular monitoring of the
adherence to CPGs and of the impact of interventions to improve appropriateness.
Keywords: tumour markers, imaging exams, adherence to guidelines, routinely collected health data.