A retrospective study of do-not-do practice recommendations in metastatic breast cancer in Spain

Introduction

34 722 incident cases of breast cancer were diagnosed in Spain in 2022. At the time of initial diagnosis, 5%–6% already presented metastasis. In 2007, The National Institute for Health and Care Excellence published a set of recommendations about low-value practices commonly known as “do-not-do” (DND), which lead to initiatives to decrease the overuse of health resources. The aim of our study was to collect, based on an expert consensus, DND recommendations for metastatic breast cancer and assess frequency of adherence in the real world.

Methods

Mixed analysis based on a literature review that combined a qualitative analysis (a panel of 10 experts reached an agreement on a list of criteria by consensus building) and a quantitative analysis (observational retrospective study assessing codified clinical information from electronic health records [EHRs] about the DND recommendations in 4 Spanish university hospitals).

Results

Consensus was reached on 12 recommendations based on the review of 826 EHR from the participating hospitals. The review revealed a 1.3%–28.1% range for improvement in the adherence to the recommendations. The DND recommendation with the higher non-adherence rate was do not start the locoregional metastatic treatment of the primary tumor, except in those with stable systemic disease.

Conclusions

DND recommendations for metastatic breast cancer provide an opportunity to reduce costs and unnecessary procedures, increasing patient safety and the sustainability of the healthcare system.