[Breast cancer: analysis of treatment quality in Germany 2004: retrospective survey by Arbeitsgemeinschaft Gynäkologische Onkologie (AGO)]. / Das Mammakarzinom: Versorgungslage und Therapiequalität in Deutschland 2004. Eine retrospektive Analyse der Organgruppe Mamma der Arbeitsgemeinschaft Gynäkologische Onkologie (AGO).

The Organgruppe Mamma der Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) conducted a nationwide 3-phase analysis of the care structure and standard of therapy given to patients with breast cancer from 2002 (4th quarter) to 2004 (4th quarter). The analysis includes 1069 patients from 257 institutions; 34% with early breast cancer and 66% with metastatic disease. No reliable data on the pattern of care of these patients have been published to date in Germany. The extent to which national and international therapy recommendations were implemented in routine clinical practice was unclear. Evaluation of the data shows that treatment based on the guidelines is now being implemented very reliably in certain sectors. This is of particular relevance to the pattern of adjuvant treatment in early breast cancer. At that time 68 % of the patients received an anthracyclin based chemotherapy and in addition 18% received an anthracycline and taxane based chemotherapy. Participation in clinical trials peaked with 30% in the neoadjuvant setting. The problem with metastatic breast cancer is the complexity of the interdisciplinary treatment involved. The present analysis conducted by the AGO was the first attempt to analyse the treatment given to metastatic patients and to systematise the approach to treatment. The fundamental problem remains, irrespective of the stage of the tumour, namely that too few patients are treated in randomised clinical studies.

Pattern of care and impact of participation in clinical studies on the outcome in ovarian cancer.

The purpose of this study was to evaluate the pattern and quality of care for ovarian cancer in Germany and analyze prognostic factors with emphasis on characteristics of treating institutions, hospital volume, and participation in clinical trials. This study utilized national survey including patients with histologically proven invasive epithelial ovarian cancer diagnosed in the third quarter of 2001 including descriptive analysis of pattern of surgical care and systemic treatment in early (FIGO I-IIA) and advanced (FIGO IIB-IV) ovarian cancer and both univariate and multivariate analysis of prognostic factors. One third of all patients diagnosed in the third quarter of 2001 in Germany, 476 patients, were included. Standard care according to German guidelines was provided to only 35.5% of patients with early ovarian cancer. Recommended chemotherapy was given to 78% in advanced disease. Multivariate analysis showed advanced stage, poor performance status, comorbidity, ascites, and treatment in an institution not participating in cooperative studies to be associated with inferior survival. Non-participation was associated with an 82% increase of risk (HR = 1.82; 95% CI, 1.27-2.61; P= 0.001). Hospital volume did not affect treatment outcome. Adherence to treatment guidelines showed remarkable variety among German hospitals, indicating options and need for improvement. Selecting an institution that participates in cooperative trials might be an option for individual patients seizing the chance for better quality of care even when individual factors might hamper enrollment in a study.

[The Quality Assurance Program of the AGO Organkommission OVAR (QS-OVAR): Pattern of Care and Reality in Germany 2001]. / Das Qualitätssicherungsprogramm der AGO Organkommission OVAR (QS-OVAR): Versorgungsstruktur und Realität in Deutschland 2001.

PURPOSE: To evaluate pattern and quality of care for ovarian cancer in Germany and analyze adherence to treatment guidelines as well as prognostic factors for survival. METHODS: Nationwide survey including patients with histological proven invasive epithelial ovarian cancer diagnosed in the third quarter 2001 including descriptive analysis of pattern of surgical care and systemic treatment in early (FIGO I-IIA) and advanced (FIGO IIB-IV) ovarian cancer and both univariate and multivariate analysis of prognostic factors. RESULTS: 476, representing more than one third of all patients diagnosed in Q III 2001 in Germany were included. Standard care according to German guidelines was provided to only 35.5 % of patients with early ovarian cancer. Optimal debulking was reported for 61.4 % patients with FIGO stages IIB-IV. Recommended platinum-paclitaxel chemotherapy was given to 3 out of 4 patients in advanced disease. Multivariate analysis showed advanced stage, poor performance status, co-morbidity, ascites, postoperative tumor residuals, and less than standard care to be associated with inferior survival. CONCLUSIONS: Adherence to treatment guidelines showed remarkable variety among German hospitals indicating options and need for improvement.

[Impact of center characteristics on outcome in ovarian cancer in Germany]. / Welchen Einfluss haben Klinikmerkmale auf die Prognose beim Ovarialkarzinom in Deutschland?

PURPOSE: To evaluate the relationship between hospital characteristics and quality of care and outcome in ovarian cancer in Germany. METHODS: This 2nd national survey in patients with histologically proven epithelial ovarian cancer diagnosed in the 3 (rd) quarter 2001 analyzed pattern of care in early (FIGO I-II A) and advanced (FIGO II B-IV) disease. We performed univariate and multivariate analysis of the role of hospital characteristics, like hospital-volume, participation in cooperative clinical studies, and hospital category (university vs central clinic vs. two lower categories in Germany) as prognostic factor. RESULTS: 165 hospitals documented 476 patients (= about one third of all patients diagnosed in Germany within one quarter). Patients treated in study-centres received more frequently standard care and showed superior survival (multivariate analysis including biologic prognostic factors: HR 1.71; 95 % CI 1.2-2.5; p = 0.007). 2-year-survival was 72 % and 64 % in study-centres and hospitals not participating in studies, respectively. Neither hospital category nor hospital-volume showed any significant impact on survival. Only analysis of surrogate parameters like pattern of care in early ovarian cancer revealed advantages related to hospital category. Furthermore, analysis of some surgical details revealed advantages for high-volume centres and hospital category. CONCLUSION: Participation in clincal studies was the only transparent hospital characteristic with significant impact on prognosis of ovarian cancer. Study participation as criterion for quality of care should be included in counselling ovarian cancer patients and should help guiding selection of hospitals for primary therapy. All German hospitals with information about participation in cooperative clinical studies as well as in this quality assurance program are listed on the web.