Physicians’ attitudes and perceived barriers to adherence to the national breast cancer clinical practice guidelines in Mexico: a survey study

Background Adherence to clinical practice guidelines improves outcomes for patients with breast cancer. However, their implementation may not be feasible in low- and middle-income countries. This study aimed to evaluate physicians’ adherence, attitudes, and barriers towards the Colima Consensus, which is the Mexican national breast cancer clinical practice guideline. Methods A cross-sectional, 31-item survey was e-mailed to Consensus attendees and members of the Mexican Society of Oncology and Mexican Mastology Association. Descriptive statistics, univariate, and multivariate analysis were used to analyze the associations between participants’ characteristics, adherence, attitudes, and barriers. Result Of 439 respondents, 78% percent adhered to Consensus recommendations and 94% believed it was applicable to their clinical practice. Forty percent reported using the Consensus as their sole breast cancer guideline. This was associated with being a surgical oncologist (OR 3.3, 95% CI 2.0–5.3) and practicing at a public hospital (OR 2.1, 95% CI 1.2–3.7). The most common barriers to adherence were lack of resources and logistical problems. Regarding attitudes towards the Consensus, 90% considered it a good educational tool, 89% considered it a reliable source of information, and 90% thought it improved quality of care. Conclusions We showed high levels of adherence and positive attitudes towards the Colima Consensus, with a significant proportion of physicians using it as their only guideline. Lack of resources and logistical issues were the main barriers to adherence. Our results highlight the relevance of local breast cancer guidelines and suggest a need for the creation of resource-stratified guidelines (AU)

Physicians' attitudes and perceived barriers to adherence to the national breast cancer clinical practice guidelines in Mexico: a survey study.

BACKGROUND: Adherence to clinical practice guidelines improves outcomes for patients with breast cancer. However, their implementation may not be feasible in low- and middle-income countries. This study aimed to evaluate physicians' adherence, attitudes, and barriers towards the Colima Consensus, which is the Mexican national breast cancer clinical practice guideline. METHODS: A cross-sectional, 31-item survey was e-mailed to Consensus attendees and members of the Mexican Society of Oncology and Mexican Mastology Association. Descriptive statistics, univariate, and multivariate analysis were used to analyze the associations between participants' characteristics, adherence, attitudes, and barriers. RESULTS: Of 439 respondents, 78% percent adhered to Consensus recommendations and 94% believed it was applicable to their clinical practice. Forty percent reported using the Consensus as their sole breast cancer guideline. This was associated with being a surgical oncologist (OR 3.3, 95% CI 2.0-5.3) and practicing at a public hospital (OR 2.1, 95% CI 1.2-3.7). The most common barriers to adherence were lack of resources and logistical problems. Regarding attitudes towards the Consensus, 90% considered it a good educational tool, 89% considered it a reliable source of information, and 90% thought it improved quality of care. CONCLUSIONS: We showed high levels of adherence and positive attitudes towards the Colima Consensus, with a significant proportion of physicians using it as their only guideline. Lack of resources and logistical issues were the main barriers to adherence. Our results highlight the relevance of local breast cancer guidelines and suggest a need for the creation of resource-stratified guidelines.

Simposio. Avances recientes con ifosfamida/mesna en el tratamiento de tumores sólidos malignos: etopósido, platino, ifosfamida y dexametasona como tratamiento de rescate en los linfomas no Hodgkin / Symposium on recent advances with ifosfamide/Mesna in the treatment of malignant solid tumors

Existen grandes avances en el manejo de los linfomas; desafortunadamente un porcentaje variable de casos recaerán a regímenes de primera línea. Se informan los resultados preliminares de 17 pacientes con diagnóstico de linfoma de Hodgkin refractarios a manejo de primera línea o refractarios. El esquema utilizado fue cada 3-4 semanas: combinación de etopósido 100 mg/m² por tres días, platino 100 mg/m² e ifosfamida 5g/m² fraccionados en tres días, mesna al 20 por ciento de la dosis diaria de ifosfamida por tres dosis; y dexametasona de 20 a 40 mg cada 24 horas por tres días. Trece de los 17 pacientes fueron evaluables para eficacia (dos aún en tratamiento; los otros dos abandonaron la terapia) y 16 fueron evaluables para toxicidad en 74 ciclos administrados. Se obtuvieron 11 respuestas totales (84 por ciento): seis respuestas (46 por ciento) Äcon supervivencia libre de enfermedad mínima de dos meses y máxima de 11 mesesÄ y cinco respuestas parciales (38 por ciento). La toxicidad más frecuente y grave fue neutropenia grado 4 (20 por ciento) con dos muertos por septicemia y plaquetopenia grado 4 (7 por ciento). El resto de los efectos tóxicos fueron leves y reversibles. No se observó toxicidad vasical. Concluimos que el esquema utilizado es efectivo, pero conlleva toxicidad grave en una cuarta parte de los ciclos. Consideramos que es conveniente incluir factores estimulantes de colonias en este tratamiento