[Use of guidelines and heterogeneity of decision making for adjuvant chemotherapy in hormone-receptor positive, HER2-negative, early breast cancer: results of a French national survey].
Adjuvant chemotherapy for localised breast cancer aims at reducing the risk of relapse and at increasing overall survival. Decision criteria include tumour burden and biological profile. It appears currently difficult to evaluate the benefit/risk ratio in certain borderline cases, which are more and more frequent. We have evaluated through an anonymous web survey conducted as part of the 2013 Annual Saint-Paul-de-Vence breast conference, the chemotherapy decisions, use of guidelines and level of certainty with decisions in this type of situation through four clinical cases. The survey was proposed to 1,190 French physicians who are directly in charge of breast cancer care, whatever their specialty. Three hundred and fifty-three of them replied, of whom 67 % were oncologists and 15 % surgeons. A significantly heterogeneous decision was observed for two out of four cases, in which 52 and 69 % of the physicians opted for adjuvant chemotherapy, versus 48 and 21 % for abstention respectively. Eighty seven percent of responding physicians used guidelines to guide their decision. These guidelines were regional for 63 %, national for 36 %, local in 21 % and international in 16 % of the cases. The level of certainty varied with clinical cases but not with the physician's specialty, nor type of decision.
Institut Gustave-Roussy, Comité de pathologie mammaire, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
Mahmoud
M
Fekih
Centre Paul-Strauss, Département de médecine, 3 rue de la Porte-de-l'hôpital, 67000 Strasbourg, France.
Thierry
T
Petit
Chirurgie du sein, 17, rue Pétrarque 75116 Paris, France, Institut Curie, Département de bio-pathologie, 35, rue Dailly, 92210 Saint-Cloud, France.
Daniel
D
Zarca
Institut Curie, Département de bio-pathologie, 35, rue Dailly, 92210 Saint-Cloud, France.
Jean-Marc
JM
Guinebretière
Institut Gustave-Roussy, Comité de pathologie mammaire, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
Fabrice
F
André
Département de médecine oncologique, Institut Curie, 26, rue d'Ulm 75005 Paris, France. Université Paris Descartes, Paris, France.
Jean-Yves
JY
Pierga
Centre azuréen de Cancérologie, 1, place du Docteur Jean-Luc-Broquerie, 06250 Mougins, France.
Moïse
M
Namer
Université Paris VI-Sorbonne, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France.
Joseph
J
Gligorov
Institut Gustave-Roussy, Comité de pathologie mammaire, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
Suzette
S
Delaloge
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis; D001943:Breast Neoplasms / Q000737:chemistry* / Q000188:drug therapy* / Q000473:pathology; D017024:Chemotherapy, Adjuvant / Q000592:standards*; D003657:Decision Making; D005260:Female; D005602:France; D013502:General Surgery / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006801:Humans; D008495:Medical Oncology / Q000706:statistics & numerical data; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D017410:Practice Guidelines as Topic; D018787:Radiation Oncology / Q000706:statistics & numerical data
D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor
adjuvant; biomarkers; breast neoplasms; chemotherapy; prognosis