Use of a physician-directed questionnaire to define a consensus about management of breast cancer: implications for assessing costs and benefits of treatment.
The present study was designed to assess the preferred methods of treatment of early breast cancer by United States oncologists, to define the impact of published clinical trials on their practice, and to define questions related to clinical decision making that should be subjected to further research. A questionnaire was mailed to 405 oncologists of all three disciplines (medical, radiation, and surgical oncology) and to 60 oncology nurses who practice in the United States. The questionnaire included clinical scenarios of: (a) a patient with primary breast cancer; (b) a premenopausal woman with node-negative breast cancer; and (c) a postmenopausal woman with estrogen receptor (ER)-negative, node-positive breast cancer. Respondents were asked to describe their preferred management for each scenario. Our study demonstrates a consensus that modified radical mastectomy, or partial mastectomy plus radiation therapy, should be offered as equal options to selected patients with primary breast cancer; this consensus is supported by results of clinical trials. We also found agreement that adjuvant chemotherapy should be offered to premenopausal women with node-negative, ER-negative breast cancer. There was a similar consensus in favor of adjuvant chemotherapy for postmenopausal patients with ER-negative, node-positive breast cancer, despite the absence of improvement in overall survival in large, mature, controlled randomized trials (and in a meta-analysis). We suggest that further research be undertaken into factors that influence decision making by oncologists when they consider the administration of adjuvant chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)
Tannock
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Department of Medicine, Princess Margaret Hospital, Toronto, ON, Canada.
Belanger
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D001943:Breast Neoplasms / Q000737:chemistry / Q000191:economics / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008198:Lymph Nodes; D008593:Menopause / Q000502:physiology; D010818:Practice Patterns, Physicians'; D011960:Receptors, Estrogen / Q000032:analysis; D012307:Risk Factors; D011795:Surveys and Questionnaires
D011960:Receptors, Estrogen