PURPOSE: Patients with cancer are not always treated according to available guidelines. Factors such as age and comorbidities are frequently used as arguments for nonadherence. The aim of this study was to measure guideline adherence with guideline-based indicators for patients with non-Hodgkin's lymphoma (NHL) and to examine the need for improvement, considering relevant arguments. METHODS: A RAND-modified Delphi procedure was used to systematically develop NHL indicators. We evaluated their improvement potential (defined as < 90% score) in a random sample of patients with NHL (N = 431) diagnosed in 2006-2007 in 22 hospitals in the Netherlands with data from medical records. Multilevel logistic regression analyses were used to estimate the relationship between indicator scores and factors: comorbidity index (combined with age), stage, patient's objections, and lymphoma type. Scores were adjusted for significant factors. RESULTS: Of the 20 indicators developed, 16 had improvement potential. Scores were lowest for assessment of International Prognostic Index, 21%; imaging of neck, thorax, and abdomen and bone marrow examination during the diagnostic process, 23%, and after chemotherapy, 37%; adequate pathology reporting, 11%; and multidisciplinary discussion of patients, 21%. Scores for eight indicators were better for patients with a low Charlson index, stage III or IV disease, no objections to care, and aggressive lymphoma. After adjustments, adherence to all but one indicator (administration of the combination of rituximab and cyclophosphamide-doxorubicin-vincristine-prednisone) remained < 90%. CONCLUSION: In the Netherlands, almost all indicators for NHL needed improvement. This should be evaluated in other countries as well. International efforts should be undertaken to improve the quality of care of this often curable malignancy.
PURPOSE:Patients with cancer are not always treated according to available guidelines. Factors such as age and comorbidities are frequently used as arguments for nonadherence. The aim of this study was to measure guideline adherence with guideline-based indicators for patients with non-Hodgkin's lymphoma (NHL) and to examine the need for improvement, considering relevant arguments. METHODS: A RAND-modified Delphi procedure was used to systematically develop NHL indicators. We evaluated their improvement potential (defined as < 90% score) in a random sample of patients with NHL (N = 431) diagnosed in 2006-2007 in 22 hospitals in the Netherlands with data from medical records. Multilevel logistic regression analyses were used to estimate the relationship between indicator scores and factors: comorbidity index (combined with age), stage, patient's objections, and lymphoma type. Scores were adjusted for significant factors. RESULTS: Of the 20 indicators developed, 16 had improvement potential. Scores were lowest for assessment of International Prognostic Index, 21%; imaging of neck, thorax, and abdomen and bone marrow examination during the diagnostic process, 23%, and after chemotherapy, 37%; adequate pathology reporting, 11%; and multidisciplinary discussion of patients, 21%. Scores for eight indicators were better for patients with a low Charlson index, stage III or IV disease, no objections to care, and aggressive lymphoma. After adjustments, adherence to all but one indicator (administration of the combination of rituximab and cyclophosphamide-doxorubicin-vincristine-prednisone) remained < 90%. CONCLUSION: In the Netherlands, almost all indicators for NHL needed improvement. This should be evaluated in other countries as well. International efforts should be undertaken to improve the quality of care of this often curable malignancy.
Authors: Jonathan W Friedberg; Michelle Byrtek; Brian K Link; Christopher Flowers; Michael Taylor; John Hainsworth; James R Cerhan; Andrew D Zelenetz; Jamie Hirata; Thomas P Miller Journal: J Clin Oncol Date: 2012-08-20 Impact factor: 44.544
Authors: Kristina Stojkov; Tobias Silzle; Georg Stussi; David Schwappach; Juerg Bernhard; David Bowen; Jaroslav Čermák; Avinash G Dinmohamed; Corien Eeltink; Sabrina Eggmann; Pierre Fenaux; Ulrich Germing; Manuel Haschke; Eva Hellstrom-Lindberg; Monika Heger; Arjan A van de Loosdrecht; Jakob Passweg; Michael Pfeilstöcker; Uwe Platzbecker; Luca Malcovati; António Medina de Almeida; Moshe Mittelman; Christine Morgenthaler; David P Steensma; Valeria Santini; Reinhard Stauder; Argiris Symeonidis; Sämi Schär; Charlotte Maddox; Theo de Witte; Julia Bohlius; Nicolas Bonadies Journal: Blood Adv Date: 2020-08-25
Authors: J J C Stienen; P B Ottevanger; L Wennekes; S A M van de Schans; H M Dekker; R W M van der Maazen; J H J M van Krieken; N M A Blijlevens; R P M G Hermens Journal: Ann Hematol Date: 2015-03-15 Impact factor: 3.673
Authors: Jozette J C Stienen; Rosella P M G Hermens; Lianne Wennekes; Saskia A M van de Schans; Helena M Dekker; Nicole M A Blijlevens; Richard W M van der Maazen; Eddy M M Adang; Johan H J M van Krieken; Petronella B Ottevanger Journal: Implement Sci Date: 2013-07-09 Impact factor: 7.327
Authors: Jozette Jc Stienen; Petronella B Ottevanger; Lianne Wennekes; Helena M Dekker; Richard Wm van der Maazen; Caroline Mpw Mandigers; Johan Hjm van Krieken; Nicole Ma Blijlevens; Rosella Pmg Hermens Journal: JMIR Res Protoc Date: 2015-01-09
Authors: Lydia F J van Overveld; Robert P Takes; Thomas W Vijn; Jozé C C Braspenning; Jan P de Boer; John J A Brouns; Rolf J Bun; Boukje A C van Dijk; Judith A W F Dortmans; Emilie A C Dronkers; Robert J J van Es; Frank J P Hoebers; Arvid Kropveld; Johannes A Langendijk; Ton P M Langeveld; Sjoukje F Oosting; Hendrik P Verschuur; Jan G A M de Visscher; Stijn van Weert; Matthias A W Merkx; Ludi E Smeele; Rosella P M G Hermens Journal: Health Expect Date: 2017-06-15 Impact factor: 3.377
Authors: Jozette J C Stienen; Rosella P M G Hermens; Lianne Wennekes; Saskia A M van de Schans; Richard W M van der Maazen; Helena M Dekker; Janine Liefers; Johan H J M van Krieken; Nicole M A Blijlevens; Petronella B Ottevanger Journal: BMC Cancer Date: 2015-08-08 Impact factor: 4.430