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12.08.2016 | Epidemiology | Ausgabe 2/2016

Breast Cancer Research and Treatment 2/2016

Adjuvant systemic therapy in early breast cancer: impact of guideline changes and clinicopathological factors associated with nonadherence at a nation-wide level

Zeitschrift:
Breast Cancer Research and Treatment > Ausgabe 2/2016
Autoren:
A. M. F. Verschoor, A. Kuijer, J. Verloop, C. H. Van Gils, G. S. Sonke, A. Jager, T. van Dalen, S. G. Elias
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s10549-016-3940-7) contains supplementary material, which is available to authorized users.

Abstract

Over recent years, adjuvant systemic treatment guidelines (AST) for early-stage breast cancer have changed considerably. We aimed to assess the impact of these guideline changes on the administration of AST in early-stage breast cancer patients and to what extent these guidelines are adhered to at a nation-wide level. We used Netherlands Cancer Registry data to describe trends in AST prescription, adherence to AST guidelines, and to identify clinicopathological determinants of nonadherence. Between 1990 and 2012, 231,648 Dutch patients were diagnosed with early breast cancer, of whom 124,472 received AST. Adjuvant endocrine treatment (ET) use increased from 23 % of patients (1990) to 56 % (2012), and chemotherapy from 11 to 44 %. In 2009–2012, 8 % of patients received ET and 3 % received chemotherapy without guideline indication. Conversely, 10–29 % of patients did not receive ET and chemotherapy, respectively, despite a guideline indication. Unfavorable clinicopathological characteristics generally decreased the chance of undertreatment and increased the chance for overtreatment. Remarkable was the increased chance of ET undertreatment in younger women (RR < 35 vs 60–69 years 1.79; 95 % CI 1.30–2.47) and in women with HER2+ disease (RR 1.64; 95 % CI 1.46–1.85). Over the years, AST guidelines expanded resulting in much more Dutch early breast cancer patients receiving AST. In the majority of cases, AST administration was guideline concordant, but the high frequency of chemotherapy undertreatment in some subgroups suggests limited AST guideline support in these patients.

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Zusatzmaterial
Supplementary material 1 (DOC 1322 kb)
10549_2016_3940_MOESM1_ESM.doc
Supplementary material 2 (JPEG 379 kb)
10549_2016_3940_MOESM2_ESM.jpg
Literatur
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