title: A survey of Australian and New Zealand clinical practice with neoadjuvant systemic therapy for breast cancer.
abstract: BACKGROUND
  Neoadjuvant systemic therapy (NAST) has become an established treatment option for women with operable breast cancer.
  
  
  OBJECTIVE
  We aimed to better understand NAST treatment patterns, barriers and facilitators in Australia and New Zealand.
  
  
  METHODS
  We undertook a cross-sectional survey of the current clinical practice of Australian and New Zealand breast cancer specialists. Questions included referral patterns for NAST, patient selection, logistics, decision making and barriers.
  
  
  RESULTS
  Of 207 respondents, 162 (78%) reported routinely offering NAST to selected patients with operable breast cancer (median 9% of patients offered NAST). Specialty, location, practice type, gender or years of experience did not predict for offering NAST. In all, 45 and 58% wanted to increase the number of patients who receive NAST in routine care and in clinical trials respectively. Facilitators included the multidisciplinary team meeting and access to NAST clinical trials. Specialist-reported patient barriers included: patient desire for immediate surgery (63% rated as important/very important); lack of awareness of NAST (50%); concern about progression (43%) and disinterest in downstaging (32%). Forty-three per cent of participants experienced system-related barriers to the use of NAST, including other clinicians' lack of interest (27%); lack of clinical trials (24%) and unacceptable wait for a medical oncology appointment (37%).
  
  
  CONCLUSIONS
  This group of Australian and New Zealand clinicians are interested in NAST for operable breast cancer in routine care and clinical trials. Patient- and system-related barriers that prevent the optimal uptake of this treatment approach will need to be systematically addressed if NAST is to become a more common approach.
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.|Trials Coordination Department, Australia and New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia.|Schools of Psychology, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: N
authors.initials: N
authors.lastname: Zdenkowski
authors.affiliation: Schools of Psychology, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Butow
authors.affiliation: The Breast Service, Royal Melbourne and Royal Women's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: G B
authors.initials: GB
authors.lastname: Mann
authors.affiliation: Trials Coordination Department, Australia and New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Fewster
authors.affiliation: Trials Coordination Department, Australia and New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Beckmore
authors.affiliation: Department of Medical Oncology, MidCentral Regional Cancer Treatment Service, Palmerston North, New Zealand.
authors.forename: R
authors.initials: R
authors.lastname: Isaacs
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Douglas
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.|Trials Coordination Department, Australia and New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia.|Schools of Medicine, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: F M
authors.initials: FM
authors.lastname: Boyle
mesh_terms: D001315:Australia; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000601:surgery; D002986:Clinical Trials as Topic; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008495:Medical Oncology / Q000379:methods*; D020360:Neoadjuvant Therapy; D009520:New Zealand; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D013514:Surgical Procedures, Operative; D011795:Surveys and Questionnaires
keywords: breast neoplasm; chemotherapy; neoadjuvant; questionnaire; surgery