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Controversial issues in early-stage breast cancer: a global collaborative survey, supported by the European Society
D Zardavas1, F Ades1, I B Spasojevic1
1Department of Medical Oncology, Institut Jules Bordet, Brussels.
Background:
To explore the current clinical management of early-stage breast cancer (BC) patients, identify areas of controversy, and interrogate how treating physicians implement latest advances.
Methods:
We conducted a 27-item survey, disseminated in two stages: paper distribution at selected BC sessions at the ESMO 2012 Congress, and dedicated mailings to ESMO members. Descriptive statistical analysis and logistic regression analysis were applied to explore potential associations between the demographic characteristics of the participants and replies.
Results:
A total of 512 physicians from 79 countries participated in the study, accounting for 465 (91%) fully completed questionnaires. The majority of the participants were ESMO members (66%), medical oncologists (86.5%), and working in multidisciplinary teams (91.6%). Heterogeneous results were captured, such as the following: 40.9% of the participants consider no genetic test useful for making adjuvant treatment decisions; 15.3% consider PET-CT a useful imaging modality for staging; 68.8% consider that postmenopausal patients with hormone receptor positive disease should always be offered an aromatase inhibitor as part of their adjuvant therapy; 78.7% prefer to administer trastuzumab concurrently with the taxane component of chemotherapy; and 27% would consider bevacizumab in the neoadjuvant setting. The logistic regression analysis did not identify any strong predictor of the probability of giving a reply fully compatible with evidence in the literature.
Conclusion:
This survey captures clinical practice and whether the latest research advances are implemented in the treatment of early-stage BC by an extended number of physicians. Significant individual differences were found. Areas of controversy were detected, and they deserve further exploration in order to generate 'tailored' educational tools, with the final goal being the standardization of the treatment of early-stage BC patients.
