Current decisions on neoadjuvant chemotherapy for early breast cancer: Experts’ experiences in the Netherlands

• Published in: Patient education and counseling 2018-12, Vol.101 (12), p.2111-2115
• Main Authors: Spronk, P.E.R., de Ligt, K.M., van Bommel, A.C.M., Siesling, S., Smorenburg, C.H., Vrancken Peeters, M.T.F.D.
• Format: Article
• Language: English
• Subjects: Early breast cancer; Experts’ opinions; Neoadjuvant chemotherapy (NAC); Nursing
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2018.07.012

•An accepted indication for NAC is down staging of the tumour to enable BCS (75%).•Contradictory, 21% argued that NAC increases the risk of invasive margins.•Only 64% routinely recommended NAC when systemic therapy was indicated.•WHO status of ≥2 was stated most frequently a reason to refrain from NAC. To evaluate the opinion of surgical and medical oncologists on neoadjuvant chemotherapy (NAC) for early breast cancer. Surgical and medical oncologists (N = 292) participating in breast cancer care in the Netherlands were invited for a 20-question survey on the influence of patient, disease, and management related factors on their decisions towards NAC. A total of 138 surgical and medical oncologists from 64 out of 89 different Dutch hospitals completed the survey. NAC was recommended for locally advanced breast cancer (94%) and for downstaging to enable breast conserving surgery (BCS) (75%). Despite willingness to downstage, 64% of clinicians routinely recommended NAC when systemic therapy was indicated preoperatively. Reported reasons to refrain from NAC are comorbidities (68%), age >70 years (52%), and WHO-performance status ≥2 (93%). Opinions on NAC and surgical management were inconclusive; while 75% recommends NAC to enable BCS, some stated that BCS after NAC increases the risk of a non-radical resection (21%), surgical complications (9%) and recurrence of disease (5%). This article emphasizes the need for more consensus among specialists on the indications for NAC in early BC patients. Unambiguous and evidence-based treatment information could improve doctor-patient communication, supporting the patient in chemotherapy timing decision-making.