title: Quality of adjuvant CMF chemotherapy for node-positive primary breast cancer: a population-based study.
abstract: OBJECTIVE
  Adjuvant 'classical' oral cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) has long been the mainstay of adjuvant chemotherapy for premenopausal breast cancer patients. The Comprehensive Cancer Center North Netherlands (CCCN) breast cancer working group performed a retrospective audit of treatment guideline adherence and quality of CMF in hospitals in the CCCN area.
  
  
  METHODS
  The CMF treatment data of 251 consecutive axillary lymph node-positive breast cancer patients <50 years old, diagnosed between 1993 and 1996, were analyzed.
  
  
  RESULTS
  Ninety-four patients (42%) completed adjuvant CMF without dose adjustment or delay. Overall median relative dose intensity (RDI) was 92.6 (IQR 85.5-97.7). Sixty patients (24%) had an RDI <85, and 7% had an RDI <65. Myelotoxicity was the main reason for reductions and delays. Of 176 irradiated patients, 96% received radiotherapy simultaneously with CMF. Median CMF dose intensity nor median duration differed between patients who underwent mastectomy, mastectomy and radiotherapy, or breast-conserving therapy. Radiotherapy did not influence the median RDI (94 without versus 92 with radiotherapy). G-CSF, administered at least once to 76 patients, did not result in a higher median RDI. Median RDI was slightly higher when >3 patients/year (P=0.014) were treated by one specialist or >10 patients classified for adjuvant chemotherapy yearly in a hospital (P=0.037).
  
  
  CONCLUSIONS
  The adherence to CMF treatment guidelines was generally good. Simultaneous radiotherapy did not affect the median RDI of CMF. G-CSF had no impact on the median RDI but patient volume did influence the RDI.
authors.affiliation: Comprehensive Cancer Center North-Netherlands, P.O. Box 330, 9700 AH Groningen, The Netherlands. m.schaapveld@ikn.nl
authors.forename: Michael
authors.initials: M
authors.lastname: Schaapveld
authors.forename: Elisabeth G E
authors.initials: EG
authors.lastname: de Vries
authors.forename: Winette T A
authors.initials: WT
authors.lastname: van der Graaf
authors.forename: Renée
authors.initials: R
authors.lastname: Otter
authors.forename: Pax H B
authors.initials: PH
authors.lastname: Willemse
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008495:Medical Oncology / Q000592:standards*; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D011878:Radiotherapy; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate