Sharon F McGee1, Lisa Vandermeer2, Sasha Mazzarello2, Marta Sienkiewicz2, Carol Stober2, Brian Hutton3, Dean Fergusson3, John Hilton4, Jean-Michel Caudrelier5, Phillip Blanchette6, Mark Clemons7. 1. Department of Medicine and Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Canada. 2. The Ottawa Hospital Research Institute, Ottawa, Canada. 3. Clinical Epidemiology Department, The Ottawa Hospital Research Institute, Ottawa, Canada. 4. Department of Medicine and Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, Canada. 5. Department of Radiation Medicine, The Ottawa Hospital Cancer Centre, Ottawa, Canada. 6. London Regional Cancer Program, London, Canada. 7. Department of Medicine and Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, Canada. Electronic address: mclemons@toh.ca.
Abstract
BACKGROUND: Patients can start endocrine therapy before, concurrently with, or sequentially after radiotherapy. The optimal timing of starting adjuvant endocrine therapy is unknown. This survey was performed to evaluate physician recommendations. METHODS: Canadian oncologists were surveyed to evaluate institutional and personal practices regarding the prescription of adjuvant endocrine therapy and radiotherapy. Perspectives regarding the design of a clinical trial to compare concurrent versus sequential therapy, and the optimum end points for such a trial, were also sought. RESULTS: The overall response rate was 30% (65/220), with responses mainly from medical (35/65, 54%) and radiation (28/65, 43%) oncologists. Eighty-four percent of respondents reported an absence of institutional protocols. The majority of physicians (57%, 36/65) identified endocrine therapy provided after radiotherapy as the preferred sequence of treatments. Twenty-two percent (14/65) had no preference, while 21%, (14/65) started endocrine therapy either before or concurrent with radiotherapy. Practice patterns were largely based on the physician's own clinical experience. Thirty-two percent of physicians (21/65) had concerns regarding concurrent endocrine therapy and radiotherapy, including increased adverse effects with endocrine therapy (13/21, 62%), reduced efficacy of radiotherapy (4/21, 19%), reduced compliance with endocrine therapy (3/21, 14%), and increased radiation toxicity (1/21, 5%). Most thought a pragmatic clinical trial addressing this question would help standardize and improve patient care. CONCLUSION: Decisions around the timing of endocrine therapy and radiotherapy are largely being made on the basis of physicians' personal choices. In the absence of data to support these decisions, appropriately powered trials are needed.
BACKGROUND:Patients can start endocrine therapy before, concurrently with, or sequentially after radiotherapy. The optimal timing of starting adjuvant endocrine therapy is unknown. This survey was performed to evaluate physician recommendations. METHODS: Canadian oncologists were surveyed to evaluate institutional and personal practices regarding the prescription of adjuvant endocrine therapy and radiotherapy. Perspectives regarding the design of a clinical trial to compare concurrent versus sequential therapy, and the optimum end points for such a trial, were also sought. RESULTS: The overall response rate was 30% (65/220), with responses mainly from medical (35/65, 54%) and radiation (28/65, 43%) oncologists. Eighty-four percent of respondents reported an absence of institutional protocols. The majority of physicians (57%, 36/65) identified endocrine therapy provided after radiotherapy as the preferred sequence of treatments. Twenty-two percent (14/65) had no preference, while 21%, (14/65) started endocrine therapy either before or concurrent with radiotherapy. Practice patterns were largely based on the physician's own clinical experience. Thirty-two percent of physicians (21/65) had concerns regarding concurrent endocrine therapy and radiotherapy, including increased adverse effects with endocrine therapy (13/21, 62%), reduced efficacy of radiotherapy (4/21, 19%), reduced compliance with endocrine therapy (3/21, 14%), and increased radiation toxicity (1/21, 5%). Most thought a pragmatic clinical trial addressing this question would help standardize and improve patient care. CONCLUSION: Decisions around the timing of endocrine therapy and radiotherapy are largely being made on the basis of physicians' personal choices. In the absence of data to support these decisions, appropriately powered trials are needed.
Authors: Sharon McGee; Mashari AlZahrani; Carol Stober; Terry L Ng; Katherine Cole; Gail Larocque; Arif Awan; Sandeep Sehdev; John Hilton; Lisa Vandermeer; Brian Hutton; Gregory Pond; Deanna Saunders; Mark Clemons Journal: J Bone Oncol Date: 2021-02-19 Impact factor: 4.072
Authors: Mashari Alzahrani; Mark Clemons; Marta Sienkiewicz; Noa Shani Shrem; Sharon F McGee; Lisa Vandermeer; Sandeep Sehdev; Marie France Savard; Arif Awan; Christina Canil; Brian Hutton; Gregory Pond; Deanna Saunders; Terry Ng Journal: Support Care Cancer Date: 2021-05-22 Impact factor: 3.603
Authors: Katherine Marie Cole; Mark Clemons; Meshari Alzahrani; Gail Larocque; Fiona MacDonald; Lisa Vandermeer; Brian Hutton; Ardelle Piper; Greg Pond; Sharon McGee Journal: Breast Cancer Res Treat Date: 2021-06-22 Impact factor: 4.872