Abstract
BackgroundThis study examined 5-year overall, recurrence and distant metastasis-free survival (OS, RFS, MFS) of high- and intermediate-risk breast cancer (BC) patients who declined guideline-recommended adjuvant chemotherapy (CHT).MethodsIn the prospective multicenter cohort study BRENDA II, patients with primary BC were sampled over a period of four years (2009–2012). A multi-professional team (tumorboard) discussed recommendation for adjuvant CHT according to the German guideline. Potential differences in 5 year survival were analyzed using Kaplan–Meier curves and Cox regression. The hazard ratios (HR) were adjusted for age, Charlson Comorbidity Score, American Society of Anesthesiologist (ASA) physical status classification, and endocrine therapy.ResultsA total of 759 patients were enrolled of which 688 could receive CHT according to the guidelines (n = 219 had a clear indication, in n = 304 it was possible). For 360 patients, the tumorboard advised to perform CHT, for 304 it advised against and in 24 cases, no decision was documented. Of those with a positive suggestion, 83% received CHT. Until 5 years after diagnosis, 57 patients were deceased, 41 had at least one distant metastasis and 29 a recurrence. There was no evidence for differences in OS and MFS in patients who declined CHT despite tumorboard recommendation (HR 3.5, 95% CI 0.8–15.1 for OS, HR 1.9, 95% 0.6–6.6 for MFS). Patients who received CHT had significantly better 5-year RFS compared to those who declined (HR 0.3, 95% CI 0.1–0.9, p = 0.03). There was no evidence for different survival in those who had no CHT because of comorbidity and those who declined actively, neither for OS, MFS nor RFS.ConclusionThe prospective BRENDA II study demonstrates benefit in RFS by guideline adherence in adjuvant breast cancer treatment, indicating prospectively the value of internationally validated guidelines in breast cancer care.
Highlights
Women with primary diagnosis of early breast cancer (BC) all in all have a favorable prognosis with good survival rates [1]
A multi-professional team consisting of gynecologic, medical, and radiation oncologists, BC surgeons, pathologists, radiologists,and study nurses discussed the recommendation for adjuvant CHT based on current validated guidelines and this decision was documented in a database
759 patients with primary BC were included in the study
Summary
Women with primary diagnosis of early breast cancer (BC) all in all have a favorable prognosis with good survival rates [1]. The aim of the prospective BRENDA II study was to assess these patient-related factors that prevent patients from receiving guideline-adherent treatment. Among BC patients for whom adjuvant CHT is indicated and for whom the tumorboard recommends CHT, do those who do not receive CHT because they decline have worse outcome than those who receive it (after adjusting for comorbidities)?. This study examined 5-year overall, recurrence and distant metastasis-free survival (OS, RFS, MFS) of highand intermediate-risk breast cancer (BC) patients who declined guideline-recommended adjuvant chemotherapy (CHT). Conclusion The prospective BRENDA II study demonstrates benefit in RFS by guideline adherence in adjuvant breast cancer treatment, indicating prospectively the value of internationally validated guidelines in breast cancer care
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
