Missing operationalization of patients' quality of life in diagnostics and therapy of breast cancer in Germany

Objectives: Over the last decade quality assurance for breast cancer (BC) has seen remarkable improvements in Germany. However, quality of life (QoL) aspects of patients seem to have shifted out of focus in this process. Therefore operationalization of QoL in treatment of breast cancer patients is reviewed.

Methods: Current DGGG S3-Guideline 2012 and AGO Guideline 2013, AQUA Quality Report 2012 (18/1 Mammachirurgie), AQUA Quality Indicators 2013 and Certification Requirements for breast centers in Germany (Erhebungsbogen 2012) were analyzed regarding QoL aspects in breast cancer treatment.

Results: The term 'Lebensqualität' (QoL) is listed n = 37 in DGGG and n = 10 in AGO Guidelines, n = 3 in AQUA Quality Report, n = 1 in Certification Requirements and n = 4 in Quality Indicators but is not listed as quality indicator. Actual operationalization of QoL is vague to nonexistent. QoL is usually referred to as patients' objective interest from physicians' view. However, patients' actual QoL is formally neither assessed nor potential results formally integrated into BC treatment at present time.

Conclusions: In contrast to highly developed evidence-based, quality assured standardization of BC diagnostics and therapy, QoL of patients is neither assessed nor operationalized and implemented into BC treatment on routine base. Even worse, patients' will in contrast to guidelines and quality parameters might lead physicians into a conflict between fulfilling quality requirements vs. patients' decision against quality-assured recommendations. Present rather rigid quality assurance lacks encouraging acceptance and operationalization of patients' QoL and implementation e.g. repeated assessments of QoL and patients' will into treatment of BC without negative impact for physicians.