An Italian Oncology Research to Evaluate Adherence to Clinical Guidelines for Cancer Treatment: the Right Program

Clinical oncology societies develop and regularly update evidence-based guidelines in order to achieve more reliable and updated tools for patient management. In 2004 AIOM (Italian Association of Medical Oncology) created the RIGHT program: Research for the Identification of the most effective and hIGHly accepted clinical guidelines for cancer Treatment. It aims to evaluate the concordance between AIOM breast (BC), colorectal (CRC) and lung (LC) cancer guidelines and clinical practice in Italian cancer centers. the RIGHT program is composed by three retrospective observational studies, one for each guideline, conducted in a sample of 35 (BC) +37 (CRC) +53 (LC) Italian centers for cancer care representative of 230 AIOM centers. Site sampling from AIOM database was stratified by geographic distribution (North, Center, South). Indicators were identified to verify the concordance between AIOM guidelines and clinical practice about staging and treatment. Patients were included if they had their first visit at the site after guideline emission. Patients were then followed-up for at least 6 months. Patients enrolled for the breast, colorectal and lung cancer guideline evaluation were 324,326, and 708, respectively. Adherence was on average 69% for BC, 76% for CRC and 69% for LC. For CRC adherence was 78% for colon, 69% for rectal cancer and 83% for advanced disease. For BC, the lowest degree of compliance (0%) was observed for the follow-up indicator in asymptomatic patients. For LC, on average 67%, 46% and 81% of stage I-II-IIIA, IIIB and IV patients respectively received recommended care according to defined lung cancer indicators The RIGHT program showed that guidelines adherence is generally high, with very few cases of low adhererence. Guidelines adherence monitoring and update represent crucial activity to get more useful instrument to plan health care interventions.