Abstract
Background: In Zimbabwe, the hormone receptor status is not always available when patients with breast cancer are started on treatment. Aim: This study evaluated the discordance of treatment approach in such patients, with National Comprehensive Cancer Network (NCCN) guideline recommendations as the reference standard when these results are eventually available. Setting: Female patients who presented to the Parirenyatwa Central Hospital Radiotherapy and Oncology Centre with a histological diagnosis of breast cancer, managed between 1 January 2014 and 31 December 2016. Methods: Patients with breast cancer having unknown receptor status at diagnosis, and the hormone receptor status were subsequently available either clinically or the tissues were available for study-specific analysis, were eligible for the study. The level of agreement between treatments received and the NCCN recommendations if the receptor status was known was tested using Kappa statistic. Results: Patients in stage I–III received treatment that were in strong agreement with the use of chemotherapy, and endocrine treatments with agreement scores of 1 (95% CI 0.91–1) and 0.81 (95% CI 0.65–0.95), respectively; but moderate agreement with regard to the choice of chemotherapy regimen, with a score of 0.5 (95% CI 0.32–0.68). There was a median delay of 8 (range 3–27) months for the availability of receptor status. Of the 38 stage IV patients, 33 (87%) were recommended chemotherapy. Of the 38 patients, 25 (66%) had hormone driven disease. There was somewhat agreement for use of chemotherapy, choice of chemotherapy regimen and use of endocrine treatments as initial choice with agreement scores of 0.53 (95% CI 0.36,0.69), 0.18 (95% CI 0.07, 0.35) and 0.68 (95% CI 0.51,0.82) respectively. Conclusion: Treatment approaches were largely in agreement with the NCCN guidelines for patients in stage I–III. Discordance was noted in stage IV patients with under-utilisation of hormone therapy as the initial treatment when the receptor status was unknown.
Highlights
In Zimbabwe, the hormone receptor status is not always available when patients with breast cancer are started on treatment
Patients in stage I–III received treatment that were in strong agreement with the use of chemotherapy, and endocrine treatments with agreement scores of 1 and
Discordance was noted in stage IV patients with under-utilisation of hormone therapy as the initial treatment when the receptor status was unknown
Summary
In Zimbabwe, the hormone receptor status is not always available when patients with breast cancer are started on treatment. Great strides have been made worldwide in the treatment of breast cancer, with improved outcomes in the last three decades notably in developed countries.[1] This is attributed to the new therapeutic approaches that are biomarker based and supported by several clinical trials. Therapeutic options were largely based on stage, grade and histology amongst other prognostic factors. As technical tools were developed, biomarkers in DNA, RNA and protein levels provided an in-depth knowledge in understanding the biology of the tumour.[2]. More than 50% of breast cancer cases in sub-Saharan African countries present with local advancement to metastatic disease.[3] Management protocols are stratified according to luminal subtypes, with 70%
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