Document Type


Original Publication Date


Journal/Book/Conference Title

Annals of Translational Medicine





DOI of Original Publication


Date of Submission

December 2015


The degree to which patient care is concordant with guidelines is widely used to assess the quality of health care. Compliance with guidelines is very high for certain cancers and procedures but not for others. For example, patients with stage I-III colon cancer routinely undergo bowel resection, with very little variation in rates between regions or institutions (1). However, assuming that noncompliance to follow guidelines reflects a failure of the care providers is not so straightforward when there are many possible treatment alternatives that have very different characteristics, especially when there is controversy about whether they are equivalent. About 15% to 30% of patients with early-stage breast cancer who undergo breast-conservation surgery (BCS) do not receive whole-breast irradiation (WBI), which has been the “standard” treatment for decades. Possible alternative radiations include accelerated partial breast irradiation (APBI) using brachytherapy or external-beam irradiation and intraoperative radiotherapy (IORT) (2-5), in which a single dose is given at the time of surgery. These two approaches substantially shorten the duration and inconvenience of radiation therapy. Traditional WBI requires patients to commit to a 5-7-week course of treatment, while APBI involves once or twice-daily treatments generally given over 1-2 weeks and IORT requires no commitment beyond that the patient already has made to receiving surgery.


Yao N, Recht A. The real difficulty in improving concordance of clinical practice with guidelines. Ann Transl Med 2015;3(6):85. doi: 10.3978/ j.issn.2305-5839.2015.03.51

Is Part Of

VCU Healthcare Policy and Research Publications