Primary systemic therapy for breast cancer: Does the patient's involvement in decision-making create a new future?
OBJECTIVE
Primary systemic therapy (PST) followed by surgery is the standard initial treatment for locally advanced breast cancer (LABC). However, some patients are averse to mastectomy or breast-conserving surgery and do not consent to these procedures. The reasons for this controversial decision, the factors influencing the decision-making and optimal solutions for decision aiding need to be investigated.


METHODS
We addressed these questions by a review of literature on the possibilities associated with different patient choices and subsequent treatment options in relation to LABC.


RESULTS
A total of 5 reviews and 22 clinical studies were summarized in relation to decision making and the most successful decision aids. A discussion is given of the issues of those few patients who cannot be convinced to undergo surgery.


CONCLUSIONS
Currently there is no guideline for the treatment of patients who reject the surgical procedures after PST. Medical oncologists should be able to apply decision aid modalities in a personalized manner to give all needed information to their patients thereby ensuring a deliberate decision-making process, facilitating acceptance of a need for surgery, and thus improving the chances of prolonged survival.


CONCLUSIONS
Currently multidisciplinary tumor boards are the most suitable decision aids in oncological practice.
Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary. Electronic address: tokes.timea@med.semmelweis-univ.hu.
Tímea
T
Tőkés
Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary.
László
L
Torgyík
Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary.
Gyöngyvér
G
Szentmártoni
Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary; St. Margaret Hospital, Surgical Division, Budapest, Hungary.
Krisztián
K
Somlai
Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary.
Andrea
A
Tóth
Semmelweis University, 2nd Department of Pathology, Budapest, Hungary.
Janina
J
Kulka
Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary.
Magdolna
M
Dank
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008408:Mastectomy; D010043:Outcome and Process Assessment, Health Care / Q000639:trends*; D010358:Patient Participation
D000970:Antineoplastic Agents
Breast cancer; Breast-conserving surgery; Decision making; Decision-aid; Primary systemic therapy