The impact of local guidelines on the tumour marker requesting patterns of a General Surgery Department.

BACKGROUND: The inappropriate use of tumour markers (TMs) is a common problem. The aim of this audit was to evaluate the impact of local guidelines on the TM requesting patterns of a General Surgery Department. METHODS: CA 125, CA 19-9, CA15-3, CEA, AFP and HCG requests from all hospital surgical locations were audited over two periods of eight months before and after the implementation of local requesting guidelines. RESULTS: Postintervention, total TM requests decreased by 32% while patient requests decreased by 9.8%. Single TM requesting increased and requests for panels containing four or more TMs decreased from 279 to 60 requests (78% reduction). CONCLUSION: Interdepartmental collaboration and the implementation of local guidelines have resulted in a change in requesting behaviour, most notably a reduction in multiple TM panel requests.

An audit of tumour marker utilization in Greece.

INTRODUCTION: Several international organizations have published guidelines for the correct use of tumour markers in clinical practice. However, there are reports that clinicians do not adhere to these guidelines in clinical practice. The present study constitutes an audit of TM use in a major hospital in Northern Greece. Purpose of our study is to quantify the magnitude of inappropriate TM requests as well as the corresponding financial cost. METHODS: We examined retrospectively all TM requests between 10/2006 and 07/2007 in the department of biochemistry of our hospital. The tumour markers included in our study were: CA 19-9, CA 125, CA 15-3, AFP, NSE, CYFRA 21-1 and CEA. RESULTS: We found 9782 inappropriate TM orders. For five of them - namely CA 125, AFP, CA 19-9, CYFRA 21-1 and NSE - the proper requests were below 10%. There were 5.6 TM requests per patient. The total cost for inappropriate TM reached 239,748 euro, which corresponds to a monthly cost of 23,974euro. CONCLUSIONS: There is considerable inappropriateness in the utilization of TM in Greece which corresponds to significant financial cost. Various measures should be applied in order to increase the cost-effectiveness of TM use.

Rentabilidad de la información de la alfa fetoproteí na (AFP). Utilización de bases de datos relacionales / Profitabldity of the information of alpha fetoprotein (AFP). Utilization of data base related with

El carcinoma hepatocelular (CHC) es el más frecuente de los cánceres primitivos de hígado y desde su descubrimiento, la alfa fetoproteína (AFP) ha sido el marcador de elección para su diagnóstico y seguimiento. En base a obtener información valiosa sobre la rentabilidad diagnóstica del marcador, en cuanto a sus niveles y circunstancias de comorbilidad, se realizó un estudio de tipo retrospectivo en el área de referencia del Hospital Nuestra Señora del Pino de Las Palmas de Gran Canaria. Para ello se utilizaron los datos del laboratorio, exportados en un fichero en código ASCII, e implementados con datos demográficos y clínicos obtenidos del fichero maestro de pacientes del Hospital.Se realizaron 346 determinaciones a 159 pacientes. De ellos, 11 presentaban CHC (6 asociados con cirrosis y 4 con hepatitis), 75 cirrosis hepática (4 asociados con hepatitis), 64 presentaban otros procesos tumorales, 2 cáncer secundario de hígado y 7 otros diagnósticos. El 45 por ciento de los casos de CHC tenían niveles de AFP > 50 ng/ml y el 36.5 por ciento AFP > 500 ng/ml, frente al 5.2 por ciento y 1.3 por ciento respectivamente para los casos de cirrosis hepática. La utilización de bases de datos relacionales constituye un método eficaz, rápido y rentable en términos económicos para obtener información sobre problemas clínicos seleccionados. Abreviaturas: CHC, carcinoma hepatocelular; AFP, alfa fetoproteína; VHB, virus de la hepatitis B; VHC, virus de la hepatitis C; CH, cirrosis hepática; CEA, antígeno carcinoembrionario. (AU)