TY - JOUR
T1 - Current decisions on neoadjuvant chemotherapy for early breast cancer
T2 - Experts’ experiences in the Netherlands
AU - Spronk, P.E.R.
AU - de Ligt, K.M.
AU - van Bommel, A.C.M.
AU - Siesling, S.
AU - Smorenburg, C.H.
AU - Vrancken Peeters, M.T.F.D.
AU - On behalf of the NABON Breast Cancer Audit
PY - 2018/12
Y1 - 2018/12
N2 - Purpose: To evaluate the opinion of surgical and medical oncologists on neoadjuvant chemotherapy (NAC) for early breast cancer.Methods: Surgical and medical oncologists (N = 292) participating in breast cancer care in the Netherlands were invited for a 20-question survey on the influence of patient, disease, and management related factors on their decisions towards NAC.Results: A total of 138 surgical and medical oncologists from 64 out of 89 different Dutch hospitals completed the survey. NAC was recommended for locally advanced breast cancer (94%) and for downstaging to enable breast conserving surgery (BCS) (75%). Despite willingness to downstage, 64% of clinicians routinely recommended NAC when systemic therapy was indicated preoperatively. Reported reasons to refrain from NAC are comorbidities (68%), age >70 years (52%), and WHO-performance status ≥2 (93%). Opinions on NAC and surgical management were inconclusive; while 75% recommends NAC to enable BCS, some stated that BCS after NAC increases the risk of a non-radical resection (21%), surgical complications (9%) and recurrence of disease (5%).Conclusion: This article emphasizes the need for more consensus among specialists on the indications for NAC in early BC patients. Unambiguous and evidence-based treatment information could improve doctor-patient communication, supporting the patient in chemotherapy timing decision-making.
AB - Purpose: To evaluate the opinion of surgical and medical oncologists on neoadjuvant chemotherapy (NAC) for early breast cancer.Methods: Surgical and medical oncologists (N = 292) participating in breast cancer care in the Netherlands were invited for a 20-question survey on the influence of patient, disease, and management related factors on their decisions towards NAC.Results: A total of 138 surgical and medical oncologists from 64 out of 89 different Dutch hospitals completed the survey. NAC was recommended for locally advanced breast cancer (94%) and for downstaging to enable breast conserving surgery (BCS) (75%). Despite willingness to downstage, 64% of clinicians routinely recommended NAC when systemic therapy was indicated preoperatively. Reported reasons to refrain from NAC are comorbidities (68%), age >70 years (52%), and WHO-performance status ≥2 (93%). Opinions on NAC and surgical management were inconclusive; while 75% recommends NAC to enable BCS, some stated that BCS after NAC increases the risk of a non-radical resection (21%), surgical complications (9%) and recurrence of disease (5%).Conclusion: This article emphasizes the need for more consensus among specialists on the indications for NAC in early BC patients. Unambiguous and evidence-based treatment information could improve doctor-patient communication, supporting the patient in chemotherapy timing decision-making.
KW - Early breast cancer
KW - Experts’ opinions
KW - Neoadjuvant chemotherapy (NAC)
KW - 22/4 OA procedure
UR - http://www.scopus.com/inward/record.url?scp=85050298695&partnerID=8YFLogxK
U2 - 10.1016/j.pec.2018.07.012
DO - 10.1016/j.pec.2018.07.012
M3 - Article
AN - SCOPUS:85050298695
SN - 0738-3991
VL - 101
SP - 2111
EP - 2115
JO - Patient education and counseling
JF - Patient education and counseling
IS - 12
ER -
