H Männle1, J W Siebers2, F Momm3, K Münstedt2. 1. Gynaecology and Obstetrics, Ortenau-Klinikum Offenburg-Kehl, Ebertplatz 12, 77654, Offenburg, Germany. heidrun.maennle@ortenau-klinikum.de. 2. Gynaecology and Obstetrics, Ortenau-Klinikum Offenburg-Kehl, Ebertplatz 12, 77654, Offenburg, Germany. 3. Radio-oncology, Ortenau-Klinikum Offenburg-Kehl, Weingartenstr. 70, 77654, Offenburg, Germany.
Abstract
PURPOSE: Breast cancer patients receive treatment recommendations from multidisciplinary tumour boards. To determine the consequences of patients' refusal of such recommendations, we analysed the database of the Centre for Breast Cancer at the Ortenau Clinic in Offenburg, Germany. METHODS: A total of 4315 patients with non-metastatic primary breast cancer, treated between 1997 and 2019, were analysed with descriptive analyses, Kaplan-Meier survival analyses, and Cox regression analyses regarding the effects of their refusal. RESULTS: About 10.7% of the patients rejected the treatment advice. These were significantly elderly (F = 74.4; p < 0.001; one-way ANOVA), with greater tumour size (F = 36.7; p < 0.001; one-way ANOVA), a higher number of affected lymph nodes (F = 4.2; p = .039; one-way ANOVA), and more poorly differentiated tumours (χ2 = 16.8; df = 2; p < 0.001). The refusal of adjuvant treatment resulted in higher rates of local recurrences (χ2radiotherapy = 109.1; df = 1; p < 0.001, χ2chemotherapy = 18.3; df = 1; p < 0.001, χ2endocrine = 32.5; df = 1; p < 0.001) and poorer overall survival (χ2radiotherapy = 184.9; df = 6; p < 0.001; χ2chemotherapy = 191.8; df = 6; p < 0.001). CONCLUSIONS: All parts of the adjuvant treatment of breast cancer are clearly associated with improvements regarding disease-free and overall survival. To answer open questions about the background of patients' refusal, an analysis of prospective data collections seems necessary. In addition, patient communication should be improved so that patients understand the background of the multidisciplinary tumour board and the potential consequences of their refusal.
PURPOSE:Breast cancerpatients receive treatment recommendations from multidisciplinary tumour boards. To determine the consequences of patients' refusal of such recommendations, we analysed the database of the Centre for Breast Cancer at the Ortenau Clinic in Offenburg, Germany. METHODS: A total of 4315 patients with non-metastatic primary breast cancer, treated between 1997 and 2019, were analysed with descriptive analyses, Kaplan-Meier survival analyses, and Cox regression analyses regarding the effects of their refusal. RESULTS: About 10.7% of the patients rejected the treatment advice. These were significantly elderly (F = 74.4; p < 0.001; one-way ANOVA), with greater tumour size (F = 36.7; p < 0.001; one-way ANOVA), a higher number of affected lymph nodes (F = 4.2; p = .039; one-way ANOVA), and more poorly differentiated tumours (χ2 = 16.8; df = 2; p < 0.001). The refusal of adjuvant treatment resulted in higher rates of local recurrences (χ2radiotherapy = 109.1; df = 1; p < 0.001, χ2chemotherapy = 18.3; df = 1; p < 0.001, χ2endocrine = 32.5; df = 1; p < 0.001) and poorer overall survival (χ2radiotherapy = 184.9; df = 6; p < 0.001; χ2chemotherapy = 191.8; df = 6; p < 0.001). CONCLUSIONS: All parts of the adjuvant treatment of breast cancer are clearly associated with improvements regarding disease-free and overall survival. To answer open questions about the background of patients' refusal, an analysis of prospective data collections seems necessary. In addition, patient communication should be improved so that patients understand the background of the multidisciplinary tumour board and the potential consequences of their refusal.
Entities:
Keywords:
Breats cancer; Refusal of adjuvant treatment; Tumour board recommendation
Authors: Nancy L Keating; Mary Beth Landrum; Elizabeth B Lamont; Samuel R Bozeman; Lawrence N Shulman; Barbara J McNeil Journal: J Natl Cancer Inst Date: 2012-12-28 Impact factor: 13.506
Authors: Dawn L Hershman; Lawrence H Kushi; Theresa Shao; Donna Buono; Aaron Kershenbaum; Wei-Yann Tsai; Louis Fehrenbacher; Scarlett Lin Gomez; Sunita Miles; Alfred I Neugut Journal: J Clin Oncol Date: 2010-06-28 Impact factor: 44.544
Authors: Elisabeth Chéreau; Charles Coutant; Joseph Gligorov; Bénédicte Lesieur; Martine Antoine; Emile Daraï; Serge Uzan; Roman Rouzier Journal: Clin Breast Cancer Date: 2011-03 Impact factor: 3.225
Authors: Alfred I Neugut; Grace Clarke Hillyer; Lawrence H Kushi; Lois Lamerato; Donna L Buono; S David Nathanson; Dana H Bovbjerg; Jeanne S Mandelblatt; Wei-Yann Tsai; Judith S Jacobson; Dawn L Hershman Journal: Breast Cancer Res Treat Date: 2016-06-10 Impact factor: 4.872
Authors: W Wulaningsih; H Garmo; J Ahlgren; L Holmberg; Y Folkvaljon; A Wigertz; M Van Hemelrijck; M Lambe Journal: Breast Cancer Res Treat Date: 2018-07-21 Impact factor: 4.872
Authors: Ramon Clèries; Maria Buxó; Mireia Vilardell; Alberto Ameijide; José Miguel Martínez; Rebeca Font; Rafael Marcos-Gragera; Montse Puigdemont; Gemma Viñas; Marià Carulla; Josep Alfons Espinàs; Jaume Galceran; Ángel Izquierdo; Josep Maria Borràs Journal: Int J Environ Res Public Health Date: 2022-03-18 Impact factor: 3.390