Abstract
PurposeEUSOMA’s recommendation that “each patient has to be fully informed about each step in the diagnostic and therapeutic pathway” could be supported by guideline-based clinical decision trees (CDTs). The Dutch breast cancer guideline has been modeled into CDTs (www.oncoguide.nl). Prerequisites for adequate CDT usage are availability of necessary patient data at the time of decision-making and to consider all possible treatment alternatives provided in the CDT.MethodsThis retrospective single-center study evaluated 394 randomly selected female patients with non-metastatic breast cancer between 2012 and 2015. Four pivotal CDTs were selected. Two researchers analyzed patient records to determine to which degree patient data required per CDT were available at the time of multidisciplinary team (MDT) meeting and how often multiple alternatives were actually reported.ResultsThe four selected CDTs were indication for magnetic resonance imaging (MRI) scan, preoperative and adjuvant systemic treatment, and immediate breast reconstruction. For 70%, 13%, 97% and 13% of patients, respectively, all necessary data were available. The two most frequent underreported data-items were “clinical M-stage” (87%) and “assessable mammography” (28%). Treatment alternatives were reported by MDTs in 32% of patients regarding primary treatment and in 28% regarding breast reconstruction.ConclusionBoth the availability of data in patient records essential for guideline-based recommendations and the reporting of possible treatment alternatives of the investigated CDTs were low. To meet EUSOMA’s requirements, information that is supposed to be implicitly known must be explicated by MDTs. Moreover, MDTs have to adhere to clear definitions of data-items in their reporting.
Highlights
BackgroundThe European Society of Breast Cancer Specialists (EUSOMA) recommends that “each patient has to be fully informed about each step in the diagnostic and therapeutic pathway and must be given adequate time to consider the alternatives and make an informed decision” [1]
The main objective of this study is to evaluate the availability of the required data-items during multidisciplinary team (MDT) meetings—as verifiable in the electronic health records—for four pivotal clinical decision trees (CDTs): indication for (1) performing an magnetic resonance imaging (MRI) scan, (2) preoperative systemic treatment (PST), (3) adjuvant systemic treatment (AST) and (4) immediate breast reconstruction (IBR)
Of the 504 randomly selected patients, 110 patients were excluded for the reasons of no invasive breast cancer (n = 4), treatment for other cancer(s) in the past (n = 58), metastatic disease (n = 31), treatment received in other hospitals (n = 13), not discussed in at least one MDT meeting (n = 3) and not being diagnosed within the research period (n = 1)
Summary
BackgroundThe European Society of Breast Cancer Specialists (EUSOMA) recommends that “each patient has to be fully informed about each step in the diagnostic and therapeutic pathway and must be given adequate time to consider the alternatives and make an informed decision” [1]. As diagnostic and treatment modalities in breast cancer are increasing rapidly, clinicians are challenged to apply a growing amount of knowledge during clinical decision-making for optimal patient care. The multidisciplinary team (MDT) is supported by clinical practice guidelines, consolidating knowledge in evidence- or consensus-based recommendations aiming to improve the quality of care [2]. As guidelines are increasingly complex and dynamic, it is Breast Cancer Research and Treatment (2020) 183:355–363 challenging to overview and consider all relevant recommendations for each clinical decision. To apply CDTs, all relevant data-items for a guideline-based recommendation should be available during MDT meetings and should be reported explicitly. In case the guideline recommendation consists of more than one alternative (e.g., breast surgery vs preoperative systemic treatment), the MDT should report which alternatives will be proposed to the patient or should be waived substantiated
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