BC Cancer Agency, Vancouver, BC, Canada
Yanchini Rajmohan , Robyn Leonard , Sophie Hogeveen , Jalal Ebrahim , Dolly Han , Audrey Wong , Jean-Francois Boileau , Sonal Gandhi , Justin Lee , Robert Edward Dinniwell , Muriel Brackstone , Christine E. Simmons
Background: Locally advanced breast cancer (LABC) accounts for only 10% of all breast cancers. While several guidelines and consensus statements exist, whether the current practice reflects these guidelines is unclear. We sought to survey the oncologists in Canada to assess current practice patterns and identify areas of targeted knowledge translation interventions (KTIs) in the treatment of LABC. Methods: 426 Canadian oncologists were surveyed with a 29 item survey-tool. They were subdivided into LABC experts (n=83) and non-experts (n=343). Physicians were removed from the survey if they identified that they were not involved in the treatment of breast cancer. The survey included demographic information as well as questions as to the current practice patterns utilized in the pathway of care for LABC patients. Level of discordance was calculated between the expert and non-expert responses using a z test. Results: 139 responses were obtained (48% response rate) from the non-experts and 51 responses were obtained from the experts (61% response rate). Areas of discordance in expert and non-expert survey included: frequency of clinical assessment during neoadjuvant therapy, methods for clinical assessment, radiographic re-evaluation post therapy, and assessment of receptor status (see Table). Conclusions: Several areas have been identified as targets for KTIs that may help to improve the quality and consistency of care of patients with LABC in Canada and may also have implications for improvements in resource utilization.
Question | Expert response |
Non-expert response |
Level of disconcordance |
---|---|---|---|
Response to neoadjuvant therapy should be assessed at each cycle | 100% | 76% | 24% p = 0.0003 |
Response to NAT should be assessed by tape measure/caliper | 96% | 69% | 31% p = 0.0003 |
Radiographic re-assessment should be done after NAT in all patients | 0% | 23% | 23% p = 0.0003 |
ER/PR should be tested on core and only re-tested on final pathology if initially negative/low positive |
100% | 28% | 72% p = < 0.0001 |
HER2 should be tested on core and only re-tested on final pathology if initially negative/low positive |
93% | 27% | 66% p = < 0.0001 |
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