Health care professionals overestimate the risk for locoregional recurrences after breast cancer treatment depending on their specialty

Jet W Ankersmid,Pauline E R Spronk,Sabine Siesling,Anneke M Zeillemaker

doi:10.1007/s10549-022-06549-9

Abstract

PurposeFor the implementation of personalised surveillance, it is important to create more awareness among HCPs with regard to the risk for locoregional recurrences (LRRs). The aim of this study is to evaluate the current awareness and estimations of individual risks for LRRs after completion of primary treatment for breast cancer among health care professionals (HCPs) in the Netherlands, without using any prediction tools.MethodsA cross-sectional survey was performed among 60 HCPs working in breast cancer care in seven Dutch hospitals and 25 general practitioners (GPs). The survey consisted of eleven realistic surgically treated breast cancer cases. HCPs were asked to estimate the 5-year risk for LRRs for each case, which was compared to the estimations by the INFLUENCE-nomogram using one-sample Wilcoxon tests. Differences in estimations between HCPs with different specialities were determined using Kruskal–Wallis tests and Dunn tests.ResultsHCPs tended to structurally overestimate the 5-year risk for LRR on each case. Average overestimations ranged from 4.8 to 26.1%. Groups of HCPs with varying specialities differed significantly in risk estimations. GPs tended to overestimate the risk for LRRs on average the most (15.0%) and medical oncologists had the lowest average overestimation (2.7%).ConclusionsIt is important to create more awareness of the risk for LRRs, which is a pre-requisite for the implementation of personalised surveillance after breast cancer. Besides education for HCPs, the use of prediction models such as the INFLUENCE-nomogram can support in estimating an objective estimate of each individual patient’s risk.

Highlights

In the Netherlands, the incidence of breast cancer has been rising until 2019 and survival rates have improved [1], resulting in a growing number of breast cancer survivors eligible for follow-up care
general practitioners (GPs) tended to overestimate the risk for locoregional recurrences (LRRs) the most (15.0%) and medical oncologists had the lowest average overestimation (2.7%)
health care professionals (HCPs) with varying specialties differed significantly in risk estimations; GPs tended to overestimate the risk for LRRs the most (15.0%) and medical oncologists had the lowest average overestimation (2.7%)

Summary

Introduction

In the Netherlands, the incidence of breast cancer has been rising until 2019 and survival rates have improved [1], resulting in a growing number of breast cancer survivors eligible for follow-up care. Follow-up care can be subdivided into aftercare and surveillance. Aftercare focusses on informing on, monitoring and addressing of complaints, symptoms and (late) physical or psychosocial effects of the disease and treatment [2]. The aim of surveillance is early detection of locoregional recurrences (LRRs) or secondary primary breast tumours (SPs) [2]. Detection of LRRs and SPs is important because it might prevent the development of subsequent distant metastasis and thereby improve survival after recurrence [3, 4]. Unlike the highly personalised breast cancer treatment, surveillance is predominantly ‘one-size-fits-all’: annual imaging

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