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Breast Cancer Res Treat. 2016 Sep;159(2):357-65. doi: 10.1007/s10549-016-3940-7. Epub 2016 Aug 12.

Adjuvant systemic therapy in early breast cancer: impact of guideline changes and clinicopathological factors associated with nonadherence at a nation-wide level.

Author information

1
Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
2
Department of Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.
3
Department of Radiology, University Medical Center Utrecht, Universiteitsweg 100, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
4
Department of Research, Netherlands Comprehensive Cancer Organization, Postbus 19079, 3501 DB, Utrecht, The Netherlands.
5
Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
6
Department of Medical Oncology, Erasmus Medical Cancer Institute, Postbus 2040, 3000 CA, Rotterdam, The Netherlands.
7
Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Universiteitsweg 100, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. s.elias@umcutrecht.nl.

Abstract

Over recent years, adjuvant systemic treatment guidelines (AST) for early-stage breast cancer have changed considerably. We aimed to assess the impact of these guideline changes on the administration of AST in early-stage breast cancer patients and to what extent these guidelines are adhered to at a nation-wide level. We used Netherlands Cancer Registry data to describe trends in AST prescription, adherence to AST guidelines, and to identify clinicopathological determinants of nonadherence. Between 1990 and 2012, 231,648 Dutch patients were diagnosed with early breast cancer, of whom 124,472 received AST. Adjuvant endocrine treatment (ET) use increased from 23 % of patients (1990) to 56 % (2012), and chemotherapy from 11 to 44 %. In 2009-2012, 8 % of patients received ET and 3 % received chemotherapy without guideline indication. Conversely, 10-29 % of patients did not receive ET and chemotherapy, respectively, despite a guideline indication. Unfavorable clinicopathological characteristics generally decreased the chance of undertreatment and increased the chance for overtreatment. Remarkable was the increased chance of ET undertreatment in younger women (RR < 35 vs 60-69 years 1.79; 95 % CI 1.30-2.47) and in women with HER2+ disease (RR 1.64; 95 % CI 1.46-1.85). Over the years, AST guidelines expanded resulting in much more Dutch early breast cancer patients receiving AST. In the majority of cases, AST administration was guideline concordant, but the high frequency of chemotherapy undertreatment in some subgroups suggests limited AST guideline support in these patients.

KEYWORDS:

Adjuvant systemic therapy; Breast cancer; Chemotherapy; Endocrine therapy; Guideline adherence; Overtreatment; Undertreatment

PMID:
27514397
DOI:
10.1007/s10549-016-3940-7
[Indexed for MEDLINE]

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