Patient/oncologist decisions about adjuvant chemotherapy in ER+ve, HER2-ve early breast cancer following endopredict testing.

Abstract

e12002 Background: Endopredict is a multigene test including tumor size and nodal status; it predicts low or high risk of distant recurrence in patients (pts) with ER+ve, HER2–ve breast cancer treated with adjuvant endocrine therapy alone. We compared adj chemotherapy decisions pre and post Endopredict test results, pts’ anxiety, decisional conflict and oncologists’ (oncs) confidence about decisions made. Methods: 14 oncs in 8 UK hospitals saw 149 pts judged by clinical teams to have equivocal indications for chemotherapy. Pts and oncs discussed provisional treatment decisions based on conventional prognostic factors. Initial decisions were reconsidered when Endopredict results were available. Pre and post-test pts completed Spielberger’s State/Trait Anxiety inventory (STAI) and a decision conflict scale (DCS). Oncs answered questionnaires probing:- basic demographic,/clinical details, agreement with, and confidence about treatment decisions (endocrine (E) therapy +/- chemotherapy(C)) Results: 66.7% pts with an initial E alone decision and a high risk result upgraded to E+C. 9.4% pts with initial E+C decisions and high risk results down-graded to E. None of 46 pts initially favouring E alone who were low risk changed decisions. 82.8% who initially wanted E+C and had low risk scores downgraded to E alone. Endopredict results increased oncs’ confidence (8% ‘strongly agreed’ pre-test, 50% post-test). Oncs neither agreeing nor disagreeing with decisions fell (24% to 5%). Anxiety was stable in pts with unchanged decisions. Pts whose therapy was downgraded had significantly lower anxiety scores (p<0.01); those whose treatment was upgraded had increased scores (p<0.001). Likewise overall uncertainty on DCS fell post-test (p<0.023) Conclusions: Endopredict results increased oncs’ and pts’ decision-making confidence, improved matching of risk with therapy decisions and thus a potential for improved outcomes. Clinical trial information: ISRCTN69220108. [Table: see text]