Abstract 31: Does Receipt of Resource-Adapted Guideline-Concordant Breast Cancer Care Improve Outcomes? A Retrospective Study of 517 Breast Cancer Patients in Southwest Nigeria
Notice bibliographique
Résumé
Abstract Purpose: The NCCN Harmonized Guidelines for sub-Saharan Africa (SSA) provide evidence-based recommendations for standardized breast cancer (BC) care that are resource-appropriate, regionally developed and endorsed. This study aims to evaluate the proportion of BC patients receiving guideline concordant care in Southwest Nigeria, and their survival outcomes. Methods: A retrospective analysis was performed of consecutive patients diagnosed with non-metastatic BC at Obafemi Awolowo University Teaching Hospital, a public referral hospital in Ife, Nigeria. The NCCN Harmonized Guidelines for SSA - Breast Cancer, version 4.2021 were used to define concordant care, following the minimum practice standards for lower resource environments. Concordance was estimated with exact 95% confidence intervals. Overall survival (OS) was estimated with Kaplan Meier methods. Results: Between January 2016-December 2021, 517 patients were diagnosed with non-metastatic BC (stage I/II: n=101, 20%; stage III: n=416, 80%). Median age was 49y. Diagnostic work-up was guideline-concordant in 6.4% (n=33/517; 95%CI 4.4-8.8%). 98% (n=508/517) received a pre-treatment tissue diagnosis, 86% (n=373/435) completed an appropriate metastatic work-up, but only 18% (n=91/516) underwent breast imaging and 28% (n=142/517) had hormone receptor testing. Locoregional treatment concordance was 3.7% (n=19/517; 95% CI 2.2-5.7%) overall. 43.1% (n=223/517) of patients underwent surgery and 4.3% (n=22/517) received adjuvant radiation where indicated. 24% (n=122/517) received adjuvant chemotherapy. Guideline concordance was highest for neoadjuvant systemic treatment (55%, n=181/329; 95%CI 49-60%), followed by hormonal therapy where hormone receptor status was known (47%, n=24/51; 33-62%). Median follow-up was 17 months (IQR: 3-40). 3-year OS was 70% (59-84%) for stage I/II patients and 46% (40-53%) for stage III. Improved OS was seen across all major treatment categories for stage III patients who received guideline-concordant care compared to those who did not. Conclusion: Concordance with resource-adapted, regional practice guidelines for BC was low. Under-utilization of surgery, limited access to radiation and low rates of hormone receptor testing/therapy were key drivers of this finding. The association of concordant care with improved OS supports the utility of the guidelines & identifies areas where investments to strengthen care through guideline adherence could lead to better survival outcomes. Citation Format: Anna Dare, Olalekan Olasehinde, Matteo Di Bernardo, Funmiola Wuraola, Leye Omisore, Tosin Omoyiola, Israel Owoade, Mary Ogunyemi, Rivka Kahn, T Peter Kingham, Olusegun Alatise, Anya Romanoff. Does Receipt of Resource-Adapted Guideline-Concordant Breast Cancer Care Improve Outcomes? A Retrospective Study of 517 Breast Cancer Patients in Southwest Nigeria [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 31.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».