P E R Spronk1, K M de Ligt2, A C M van Bommel3, S Siesling4, C H Smorenburg5, M T F D Vrancken Peeters6. 1. Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands. Electronic address: p.e.r.spronk@lumc.nl. 2. Department of Research, Comprehensive Cancer Centre the Netherlands (IKNL), Utrecht, The Netherlands. 3. Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands. 4. Department of Research, Comprehensive Cancer Centre the Netherlands (IKNL), Utrecht, The Netherlands; Department of Health Technology and Services Research, MIRA Institute for Biomedical Science and Technical Medicine, University of Twente, Enschede, The Netherlands. 5. Department of Medical Oncology, Antoni van Leeuwenhoek, Amsterdam, The Netherlands. 6. Department of Surgery, Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
Abstract
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.
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.
Authors: E Heeg; Y A Civil; M A Hillen; C H Smorenburg; L A E Woerdeman; E J Groen; H A O Winter-Warnars; M T F D Vrancken Peeters Journal: Ann Surg Oncol Date: 2019-10-11 Impact factor: 5.344
Authors: Renée W Y Granzier; Abdalla Ibrahim; Sergey P Primakov; Sanaz Samiei; Thiemo J A van Nijnatten; Maaike de Boer; Esther M Heuts; Frans-Jan Hulsmans; Avishek Chatterjee; Philippe Lambin; Marc B I Lobbes; Henry C Woodruff; Marjolein L Smidt Journal: Cancers (Basel) Date: 2021-05-18 Impact factor: 6.639