Survey of treatment of primary breast cancer in Italy. GIVIO (Interdisciplinary Group for Cancer Care Evaluation).

A mail survey among 970 physicians from different specialties was carried out in Italy to learn about factors that influence physicians' decision-making for patients with early breast cancer. Ninety percent of respondents were in favour of a conservative procedure for the surgical treatment of a 35-year-old patient with primary tumour smaller than two centimeters. The same preference was also expressed by 66% of doctors for a 60-year-old patient with similar disease. Most physicians (78%) favoured the use of adjuvant chemotherapy for premenopausal node-positive women. Preferences for the treatment of post-menopausal patients were divided among those in favour of endocrine therapy (51%), chemotherapy (32%), the combination of the two (7%) or no further treatment after surgery (8%). Several factors appeared to relate to therapeutic preferences. Each physician's specialty was the single most important factor associated with the preference for surgical treatment together with the attitude towards patients' involvement in decision-making which, however, was statistically significant only for the older patient. Analysis of predictors of preferences for adjuvant therapy showed that specialty and hospital size were associated with choosing chemotherapy for a premenopausal woman, and specialty and physician's sex with the indication of endocrine treatment in a postmenopausal patient. Our study documents that the application of research results depends on many factors, some of which have a sound scientific basis while others reflect highly personal opinions and the influence of the practice environment.