Multidisciplinary Management Decisions for Newly Diagnosed Breast Cancer Patients: Our Practice in Relation to Clinical Guidelines
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- Category: Vol. 82, December 2014
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Multidisciplinary Management Decisions for Newly Diagnosed Breast Cancer Patients: Our Practice in Relation to Clinical Guidelines, LOAIE M. EL-HELW and HANAA ELKHENINI
Abstract
Purpose: Multidisciplinary care describes an integrated team approach to health care. We aimed to review the man-agement decisions of newly diagnosed breast cancer (BC) patients presented to our breast cancer multidisciplinary team (BCMDT) meetings in relation to the commonly adopted clinical guidelines.
Methods: Retrospective review of BCMDT meetings records from 01 March 2013 to 31 of July 2013 in the City General Hospital, Stoke-on-Trent, UK.
Results: There were 117 BC patients; 2 of them were males. The median age at diagnosis was 51 years (range 29- 82). Stage II was most common (40.2%). Invasive ductal carcinoma was diagnosed in 68.4%, invasive lobular carcinoma in 18.8% and ductal carcinoma in situ (DCIS) in 12.8%. HER2/neu testing was positive in 20.6%.
Sixty four patients (55%) had breast conserving surgery (BCS); 36 (30.6%) had mastectomy and 17 (14.4%) had no surgical treatment. Eighty nine patients had axillary surgery; 23 (25.8%) had sentinel lymph node biopsy (SLB) and 66 (74.2%) had axillary clearance from the start due to clinical lymphadenopathy.
Neo-adjuvant chemotherapy/hormonal treatment was recommended in 40 patients with stages II-III BC for either unresectable advanced BC (17 patients, 42%); BCS (21 patients, 53%) or triple negative BC (2 patients, 5%).
Adjuvant chemotherapy and/or hormonal treatment wer-erecommended in 47 patients with invasive BC. Nottingham prognostic index (NPI) and adjuvant online! website were used to guide the choice of systemic adjuvant treatment in 57.4% and 42.6% of patients respectively. FEC-D (fluorouracil, epirubicin, cyclophosphamide, docetaxel) ± trastuzumab was the most commonly recommended regimen both in the neo-adjuvant (82.5%) and adjuvant (74%) settings.
For DCIS patients, the Van Nuys Prognostic Index (VNPI) was used to guide decisions of adjuvant radiotherapy (ART) following BCS. Accordingly 60% were recommended ART (VNPI 7-9) and 40% completion mastectomy (VNPI 10-12).
Adjuvant radiotherapy was recommended in 79% of BC cases. Adjuvant tamoxifen and/or aromatase inhibitors were recommended for a total of 10 years for patients with Oestrogen and/or progesterone receptors breast cancer.
Fluorouracil, epirubicin and cyclophosphamide (FEC) regimen was the most commonly recommended palliative regimen (40%) in patients who had metastatic BC at their first presentation.
Genetic referral was arranged for 17% of our patients.
Conclusion: Although standardisation of guidelines is required, the use of personalised medicine should also be encouraged.