title: Utility of a web-based breast cancer predictive algorithm for adjuvant chemotherapeutic decision making in a multidisciplinary oncology center.
abstract: OBJECTIVE
  Adjuvant drug therapy can extend survival for breast cancer patients, but the balance between costs and benefits may be difficult to estimate. Software programs have been developed for this purpose and recently have become available online. Here, we describe our experience using a web-based program to support adjuvant decision making at a multidisciplinary breast cancer Tumor Board in a university-affiliated oncology center.
  
  
  METHODS
  One hundred two adjuvant breast cancer cases were discussed by the Tumor Board over a four-month period, with a provisional treatment plan being formulated after each discussion. Program data predicting 10-year risks and benefits were shared with board members after each provisional plan and any change in recommendation was recorded. A user survey was conducted to assess the perceived strengths and weaknesses of the program.
  
  
  RESULTS
  Treatment decisions were changed in 12.7 percent of cases (13/102) after consideration of data from the program. Most of these (76.9 percent) were node-negative ER-positive cases, with the most common reason for change being a lower-than-expected added survival benefit from less intensive chemotherapy regimens (ACx4 or CMF; 81.8 percent). In certain recurrent scenarios, the program was perceived to have limitations that led to retention of the original management plan despite data that might otherwise have favored different treatment. On completion of the study period, clinicians' attitudes to the program ranged from enthusiasm to caution.
  
  
  CONCLUSIONS
  Although not replacing clinical judgement, these findings support the value of this web-based program as a decision making adjunct that can help clinicians to separate risk and benefit, compare the added value of different therapeutic interventions in a given clinical context, and present more balanced information about treatment options to patients.
authors.affiliation: Department of Medicine, The University of Hong Kong, Hong Kong. repstein@hku.hk
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Epstein
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Leung
authors.forename: Joyce
authors.initials: J
authors.lastname: Mak
authors.forename: Polly S
authors.initials: PS
authors.lastname: Cheung
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D020407:Internet; D008875:Middle Aged; D012984:Software
chemical_list: D000970:Antineoplastic Agents