Patterns of use and adherence to breast cancer clinical practice guidelines among Brazilian medical oncologists: The GUIDE-Breast survey (LACOG 0924-GBECAM|D9673N00006).

Abstract

e23146 Background: Clinical practice guidelines are central to standardize breast cancer (BC) care and reduce disparities in outcomes. Understanding their integration into routine practice and the impact of access limitations is essential to guide strategies that improve equity and quality of care in Brazil. Methods: A national survey was conducted among clinical oncologists treating BC in Brazil. Domains included demographics, guideline utilization patterns, influence on clinical decision-making, and perceived barriers and facilitators to adherence. The primary endpoint was self-reported adherence to BC clinical practice guidelines. Results: Among 284 respondents, median age was 40 years (range 35.5-45.0), and 64% were female. Twelve percent treated exclusively BC, 48% mainly BC, and 40% multiple solid tumors including BC. Overall, 98% reported using guidelines to support clinical decisions, and 78% consulted them at least monthly. The SBOC guideline was most frequently considered to best reflect Brazilian clinical practice (42%), followed by ESMO (15%). Key facilitators included regularly updated evidence (24%), and ease of interpretation (22%). In contrast, the main barriers to guideline adherence were limited access to medications and/or procedures (22%), and difficulty applying guidelines to real-world clinical practice (12%). Only 19% reported full access to all guideline-recommended therapies, exams, and procedures; 38% had access to most resources, and 29% to only some resources (Table 1). Conclusions: Brazilian oncologists report high utilization of BC clinical practice guidelines. However, restrict access to guideline-recommended therapies remains a major barrier to full implementation, reinforcing persistent structural inequities in BC care and the need for system-level strategies to expand access. Guidelines utilization patterns. ASCO(American Society of Clinical Oncology) NCCN(National Comprehensive Cancer Network) ESMO(European Society for Medical Oncology) SBOC(Sociedade Brasileira de Oncologia Clínica) MOC(Manual de Oncologia Clínica) St Gallen International Consensus Guidelines for Early Breast Cancer Advanced Breast Cancer International Consensus Conference Institutional Guideline Other/None How frequently do you use this guideline in your clinical practice for breast cancer (% frequently or very frequently) 74% 89% 78% 56% 52% 27% 26% 46% - Which guideline(s) do you use to study / to keep up to date? (% checked) 60% 53% 57% 32% 34% 19% 12% 1% 5% Which guideline(s) generally influence your decisions Regarding the utilization of innovative agents? (% checked) 56% 53% 50% 31% 30% 12% 8% 8% 5%