The NeST (Neoadjuvant systemic therapy in breast cancer) study: National Practice Questionnaire of United Kingdom multi-disciplinary decision making
Creators: name: Whitehead, I.
name: Irwin, G. W.
name: Bannon, F.
name: Coles, C. E.
name: Copson, E.
name: Cutress, R. I.
name: Dave, R. V.
name: Gardiner, M. D.
name: Grayson, M.
name: Holcombe, C.
name: Irshad, S.
name: O’Brien, C.
name: O’Connell, R. L.
name: Palmieri, C.
name: Shaaban, A. M.
name: Sharma, N.
name: Singh, J. K.
name: Potter, S.
name: McIntosh, S. A.
name: Clayton, Liz
name: Copson, Ellen
name: Cox, Karina
name: Crook, Tim
name: Elsberger, Beatrix
name: Ghoneima, Ahmed
name: Hadad, Sirwan
name: Hargreaves, Anita
name: Healy, Paul
name: Heetun, Adam
name: Henderson, Dan
name: Henderson, Julia
name: Hirst, Natalie
name: Hoar, Fiona
name: Hughes, Mike
name: Iddles, Emma
name: Irshad, Sheeba
name: Irvine, Tracey
name: Jones, Stacey
name: Kaptanis, Sarantos
name: MacInnes, Emma
name: McCanny, Andrew
name: McLaughlin, Linda
name: Neal, Anthony
name: O’Connell, Rachel
name: Patani, Neill
name: Pearce, Belinda
name: Pennick, Mandana
name: Pilgrim, Simon
name: Roux, Rene
name: Rowland, Matthew
name: Saha, Sunita
name: Sharma, Kavita
name: Singh, Jagdeep
name: Sirianni, Chiara
name: Skelly, Brendan
name: Soulsby, Rachel
name: Tatterton, Mark
name: Thomas, Rob
name: Tsalic, Medy
name: Vidya, Raghavan
name: Waker, Olivia
name: Whisker, Lisa
name: Whitehead, Ian
name: Woods, Janet
Publisher: name: Apollo - University of Cambridge Repository
Year: 2021
Subjects: Research Article
Surgical oncology, cancer imaging, and interventional therapeutics
Breast cancer
Neoadjuvant treatment
Chemotherapy
Endocrine therapy
Surgery

description: Abstract: Background: Neoadjuvant systemic therapy (NST) is increasingly used in the treatment of breast cancer, yet it is clear that there is significant geographical variation in its use in the UK. This study aimed to examine stated practice across UK breast units, in terms of indications for use, radiological monitoring, pathological reporting of treatment response, and post-treatment surgical management. Methods: Multidisciplinary teams (MDTs) from all UK breast units were invited to participate in the NeST study. A detailed questionnaire assessing current stated practice was distributed to all participating units in December 2017 and data collated securely usingREDCap. Descriptive statistics were calculated for each questionnaire item. Results: Thirty-nine MDTs from a diverse range of hospitals responded. All MDTs routinely offered neoadjuvant chemotherapy (NACT) to a median of 10% (range 5–60%) of patients. Neoadjuvant endocrine therapy (NET) was offered to a median of 4% (range 0–25%) of patients by 66% of MDTs. The principal indication given for use of neoadjuvant therapy was for surgical downstaging. There was no consensus on methods of radiological monitoring of response, and a wide variety of pathological reporting systems were used to assess tumour response. Twenty-five percent of centres reported resecting the original tumour footprint, irrespective of clinical/radiological response. Radiologically negative axillae at diagnosis routinely had post-NACT or post-NET sentinel lymph node biopsy (SLNB) in 73.0 and 84% of centres respectively, whereas 16% performed SLNB pre-NACT. Positive axillae at diagnosis would receive axillary node clearance at 60% of centres, regardless of response to NACT. Discussion: There is wide variation in the stated use of neoadjuvant systemic therapy across the UK, with general low usage of NET. Surgical downstaging remains the most common indication of the use of NAC, although not all centres leverage the benefits of NAC for de-escalating surgery to the breast and/or axilla. There is a need for agreed multidisciplinary guidance for optimising selection and management of patients for NST. These findings will be corroborated in phase II of the NeST study which is a national collaborative prospective audit of NST utilisation and clinical outcomes.