Abstract P3-09-06: Frequency of and reasons for deviation from therapy decisions in patients with primary breast cancer initially intended to receive chemotherapy – Results from the German prospective multi-center study BRENDA II
Authors: Schwentner Lukas , Singer Susanne , Van Ewijk Reyn , Janni Wolfgang , Blettner Maria , Kreienberg Rolf , Wöckel Achim 
Published: May 2015

Objectives

This study examined the question, how often chemotherapy is not given to breast cancer patients when it is indicated according to guidelines and when the multi-professional tumour board (TB) decided to apply chemotherapy.

Methods

In a prospective multi-center cohort study, patients with primary breast cancer were sampled consecutively over a period of four years (2009-2012). Patients completed a questionnaire prior to surgery and prior to adjuvant therapy. This questionnaire assessed health related quality of life (QoL) using the EORTC QLQ-C30, psychiatric comorbidity with the Patient Health Questionnaire (PHQ), demographic characteristics (age, education), and the intensity of fear for chemotherapy.

After surgery, a multi-professional team discussed recommendation for chemotherapy and this decision was documented in a database together with the indication for chemotherapy according to the German S3 guideline. The multi-professional team was blinded to that algorithm-based decision. Six months later, it was documented whether the patient had received adjuvant chemotherapy or not.

Patients were included in the analysis when chemotherapy was indicated (high risk) or possible (intermediate risk) according to the guidelines and when the multi-professional team had decided to recommend chemotherapy. Risk group stratification is based on St. Gallen 2007 classification.

Statistical analysis was performed with multivariate logistic regression, separately for high and intermediate subgroup.

Results

Altogether, 857 patients were included in the study of whom based on the guideline, 241 were indicated (high risk) for chemotherapy and in 537 it was possible (intermediate risk) to apply adjuvant chemotherapy. In only 391 of those patients (accrued from high and intermediate risk subgroup), the TB decided to recommend chemotherapy. The most important reason for not recommending chemotherapy was somatic comorbidity not allowing adjuvant chemotherapy. Of those 391 patients, 73 (19%) patients had not received chemotherapy (10% of high risk, 28% of intermediate risk subgroup).

If patients where CT was recommended (according to the tumorboard decision) deviations from initial therapy decision was likely if they were old (≥75 years) and had poor QoL, (OR 0.003, p 0.001). There was also some evidence that patients with higher education (OR 0.3, p 0.07) less frequently received CT.

If patients with intermediate risk (CT possible) were very afraid of chemotherapy, deviations from initial therapy decision was likely (OR 0.4, p 0.03). In that group of patients, age, QoL, education, and comorbidity were unrelated to deviations from initial decision.

Conclusion

Even in cases where chemotherapy was indicated or possible according to guidelines and after the decision of multi-professional team to recommend it, about 19% of patients eventually did not receive chemotherapy. In those patients, this mainly happened associated with poor QoL in elderly patients &gt;75. In the intermediate risk group with chemotherapy recommendation, patient’s fear of chemotherapy is the main factor preventing patients from adjuvant chemotherapy.

Citation Format: Lukas Schwentner, Susanne Singer, Reyn Van Ewijk, Wolfgang Janni, Maria Blettner, Rolf Kreienberg, Achim Wöckel. Frequency of and reasons for deviation from therapy decisions in patients with primary breast cancer initially intended to receive chemotherapy – Results from the German prospective multi-center study BRENDA II [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-09-06.