INTRODUCTION: Adjuvant treatments are usually decided according to guidelines. However, many individual factors, such as performance status, @entity1 refusal, complex interactions between factors (eg, discrepancies between grade and Ki 67), and complex clinical features (borderline age or @entity5 size) may introduce discrepancies. The aim of this study was to quantify discrepancies between local guidelines and @entity1 management. @entity1 AND METHODS: From 2003 and 2005, 581 consecutive @entity1 underwent surgery for invasive @entity0 . @entity1 , @entity5 characteristics, and outcome were recorded. We compared @entity1 characteristics according to whether local guidelines had been followed. RESULTS: In 90% of cases local guidelines were followed. @entity1 who inadequately did not receive chemotherapy were older (P < .0001), with positive hormonal receptor status (P = .02), and @entity146 (P < .05). Main reasons for not administering chemotherapy were age, @entity1 refusal, and micrometastatic node involvement. @entity1 from the other discordant group (ie, those who inadequately received chemotherapy), had larger (P = .01) and more @entity146 (P < .0001). In these cases, the clinical decision was mainly based on @entity5 and limit lower age. For disease-free survival (DFS), we found a significant difference between groups (P = .001). The best overall survival and DFS was found for @entity1 who adequately received no adjuvant treatment. Survival among groups were similar when stratified on treatment modality. CONCLUSION: The main reasons for discrepancy were age (advanced or lower limit), @entity1 refusal, and @entity5 . In this series, deviations from recommendations had no affect on survival and raised the question of new indications for chemotherapy such as @entity5 .

Discordance with local guidelines for adjuvant chemotherapy in XXXX : reasons and effect on survival.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient', 'PATIENTS', 'Patient'] @entity0 :: ('MESH:D001943', 'Disease') :: ['breast cancer'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'multifocal tumors'] @entity146 :: ('MESH:D001523', 'Disease') :: ['less aggressive tumors', 'aggressive tumors']
@entity0 :: (MESH:D001943,Disease) :: ['breast cancer']
