title: Variation in type of adjuvant chemotherapy received among patients with stage I breast cancer: A multi-institutional Portuguese cohort study.
abstract: BACKGROUND
  A contemporary US study showed an increase in the use of chemotherapy in the last decade for some patients with stage-I breast cancer; with a rise in more intensive regimens, and declining use of anthracyclines. Nevertheless, there is still uncertainty on the absolute benefit of chemotherapy for these patients and the optimal regimen. In this study we compare those findings with the patterns of care among a Portuguese cohort of stage-I breast cancers.
  
  
  METHODS
  Retrospective cohort study of patients with stage-I breast cancer diagnosed from 2006 to 2008 at four Portuguese institutions. The use and type of chemotherapy was evaluated.
  
  
  RESULTS
  Among patients with stage I-III breast cancer 39.4% (n = 682) had stage I disease. Of the 595 eligible patients, 22.4% were treated with chemotherapy, 33.9% aged <55 years vs. 12.7% aged >65 years (p < 0.001). Thirteen percent of patients with hormone receptor (HR)+/HER2- tumors, 52.7% of patients with HER2+ and 66.0% of patients with HR-/HER2- received chemotherapy (p < 0.001). In addition, we found inter-institutional variability, with the use of chemotherapy ranging from 0.0% to 43.4% (p < 0.001). Eighty-five percent of patients treated with chemotherapy received less-intensive regimens with anthracycline-based regimens, such as doxorubicin and cyclophosphamide, being the most frequently used, while docetaxel and cyclophosphamide was only used in 1.5% of cases.
  
  
  CONCLUSIONS
  Overall, almost one-quarter of patients received chemotherapy with institutional variability. When treated, mostly less-intensive associations including anthracyclines were used, which contrasts with contemporary US practice. This study highlights the need for health-services research to understand local practices and tailor quality improvement interventions.
authors.affiliation: Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal. Electronic address: ajrsferreira@medicina.ulisboa.pt.
authors.forename: Arlindo
authors.initials: A
authors.lastname: R Ferreira
authors.affiliation: Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Palha
authors.affiliation: Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal.
authors.forename: Lurdes
authors.initials: L
authors.lastname: Correia
authors.affiliation: Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Filipe
authors.affiliation: Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal.
authors.forename: Vasco
authors.initials: V
authors.lastname: Rodrigues
authors.affiliation: Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Costa
authors.affiliation: Registo Oncológico Regional do Sul, Lisbon, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Miranda
authors.affiliation: Registo Oncológico Regional do Sul, Lisbon, Portugal.
authors.forename: Rosário
authors.initials: R
authors.lastname: André
authors.affiliation: Hospitais CUF Lisboa, Lisbon, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Fernandes
authors.affiliation: Hospitais CUF Lisboa, Lisbon, Portugal.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Gouveia
authors.affiliation: Hospital da Luz, Lisbon, Portugal.
authors.forename: José Luís
authors.initials: JL
authors.lastname: Passos-Coelho
authors.affiliation: Instituto Português de Oncologia F. G. de Lisboa, Lisbon, Portugal.
authors.forename: António
authors.initials: A
authors.lastname: Moreira
authors.affiliation: Instituto Português de Oncologia F. G. de Lisboa, Lisbon, Portugal.
authors.forename: Margarida
authors.initials: M
authors.lastname: Brito
authors.affiliation: Fundação Champalimaud, Lisbon, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Ribeiro
authors.affiliation: Dana-Farber Cancer Institute, Boston, USA.
authors.forename: Otto
authors.initials: O
authors.lastname: Metzger-Filho
authors.affiliation: Dana-Farber Cancer Institute, Boston, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: U Lin
authors.affiliation: Dana-Farber Cancer Institute, Boston, USA.
authors.forename: Inês
authors.initials: I
authors.lastname: Vaz-Luís
mesh_terms: D000368:Aged; D018943:Anthracyclines / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D017024:Chemotherapy, Adjuvant / Q000379:methods / Q000706:statistics & numerical data*; D003520:Cyclophosphamide / Q000627:therapeutic use; D000077143:Docetaxel; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011174:Portugal; D012189:Retrospective Studies; D043823:Taxoids / Q000627:therapeutic use
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents; D043823:Taxoids; D000077143:Docetaxel; D004317:Doxorubicin; D003520:Cyclophosphamide
keywords: Breast cancer; Chemotherapy; Stage I