John Libbey Eurotext

Bulletin du Cancer


Impact of clinical practice guidelines on the management for carcinomas of unknown primary site: a controlled “before-after” study Volume 96, numéro 4, avril 2009

Université de Lyon, Lyon 69008, France, Inserm U590, Lyon 69008, France, Hospices civils de Lyon, Lyon 69003, France, Department of oncology, university of Alberta, Edmonton, T6G 1Z2 Alberta, Canada, Department of oncology, centre Eugène-Marquis, 35042 Rennes, France, Department of oncology, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France, Inserm EA 4129 S-I-S, hospices civils de Lyon, 69676 Bron cedex Lyon, France

BackgroundIn 2002, the French Federation of Comprehensive Cancer Centers published clinical practice guidelines (CPGs) for the management of carcinomas of unknown primary (CUP).MethodsA controlled “before-after” study at two centers (experimental in Lyon, France and control in Edmonton, Canada) to assess the impact of CPGs on CUP management. Fifty-CUP patients treated in 2000-2001, i.e. before CPG publication, and 50 patients treated in 2003-2004, were analyzed for both centers.ResultsIn both groups, compliance for diagnostic workup was the same before or after CPGs publication. Non-adenocarcinoma histology and performance status (PS) < 2 were independent factors for CPGs compliance. In the experimental group, 75% of patients underwent inappropriate investigations. The proportion of patients from this group with unfavourable clinicopathologic entity and PS ≤ 1, who received cisplatin-based chemotherapy did not significantly change (2000-2001: 27% vs. 2003-2004: 37.5%; P = 0.45). However, most patients treated in the pre period received organ-specific regimens, while most patients treated in the post period received taxane or gemcitabine-based regimens. Patients from the control group generally received taxane/carboplatin.ConclusionsOur study show that simply distributing CUP CPGs did not change practice and underline the necessity to disseminate and implement CPGs, both to oncologists and organ-specialist physicians.