Adherence to clinical practice guidelines for adjuvant therapy of breast cance
Bibliographic record
Abstract
716 Background: Discrepancy has been observed between consensus recommendations and actual use of adjuvant chemotherapy in women with breast cancer. The objective of this study was to evaluate adherence to local clinical practice guidelines for breast cancer at a regional cancer centre. Methods: A retrospective review of patients treated between June 2001 and June 2003 was undertaken. Results: 165 charts were reviewed. 23 patients were referred for radiotherapy only. 10 had metastatic disease. Of the remaining 132 patients, 1 patient was not assessed for hormone therapy due to lack of hormone receptor staining. 6 did not have axillary lymph node dissection. 126 patients were assessed for chemotherapy. The median age was 64.2 years. Guideline adherence rates are summarized in the table. Reasons for non-adherence when the guidelines recommended adjuvant hormone therapy were: patient's choice (50%), co-morbidities (20%), clinician's judgment (20%), and elderly age (10%). Reasons for non-adherence when the guidelines recommended adjuvant chemotherapy were: co-morbidities (35%), patient's choice (24%), elderly age (24%), clinician's judgment (12%), and active infection (6%). 1 patient received chemotherapy despite guideline recommendations, based on clinician's judgment. Conclusions: Adherence to guidelines recommending adjuvant therapy is unlikely to be uniform due to patient choice and co-morbidities. At our institution, adherence to guidelines was nearly complete when no adjuvant therapy was recommended. No significant financial relationships to disclose.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.091 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".