Recent Trends in Chemotherapy Use and Oncologists’ Treatment Recommendations for Early-Stage Breast Cancer

Details

• Personal Author:
  Bondarenko I ; Friese CR ; Hamilton AS ; Hawley ST ; Hofer TP ; Jagsi R ; Katz SJ ; Kurian AW ; McLeod MC ; Ward KC
• Description:
  Background: There is growing concern about overtreatment of breast cancer as outcomes have improved over time. However, little is known about how chemotherapy use and oncologists' recommendations have changed in recent years. Methods: We surveyed 5080 women (70% response rate) diagnosed with breast cancer between 2013 and 2015 and accrued through two Surveillance, Epidemiology, and End Results registries (Georgia and Los Angeles) about chemotherapy receipt and their oncologists' chemotherapy recommendations. We surveyed 504 attending oncologists (60.3% response rate ) about chemotherapy recommendations in node-negative and node-positive case scenarios. We conducted descriptive statistics of chemotherapy use and patients' report of oncologists' recommendations and used a generalized linear mixed model of chemotherapy use according to time and clinical factors. All statistical tests were two-sided. Results: The analytic sample was 2926 patients with stage I-II, estrogen receptor-positive, human epidermal growth factor receptor 2-negative breast cancer. From 2013 to 2015, keeping other factors constant, chemotherapy use was estimated to decline from 34.5% (95% confidence interval [CI] = 30.8% to 38.3%) to 21.3% (95% CI=19.0% to 23.7%, P < .001). Estimated decline in chemotherapy use was from 26.6% (95% CI=23.0% to 30.7%) to 14.1% (95% CI=12.0% to 16.3%) for node-negative/micrometastasis patients and from 81.1% (95% CI=76.6% to 85.0%) to 64.2% (95% CI=58.6% to 69.6%) for node-positive patients. Use of the 21-gene recurrence score (RS) did not change among node-negative/micrometastasis patients, and increasing RS use in node-positive patients accounted for one-third of the chemotherapy decline. Patients' report of oncologists' recommendations for chemotherapy declined from 44.9% (95% CI=40.2% to 49.7%) to 31.6% (95% CI=25.9% to 37.9%), controlling for other factors. Oncologists were much more likely to order RS if patient preferences were discordant with their recommendations (67.4%, 95% CI=61.7% to 73.0%, vs 17.5%, 95% CI=13.1% to 22.0%, concordant), and they adjusted recommendations based on patient preferences and RS results. Conclusions: For both node-negative/micrometastasis and node-positive patients, chemotherapy receipt and oncologists' recommendations for chemotherapy declined markedly over time, without substantial change in practice guidelines. Results of ongoing trials will be essential to confirm the quality of this approach to breast cancer care. [Description provided by NIOSH]
• Subjects:
  Neoplasms Occupational Health Safety Women
• Keywords:
  Author Keywords: Chemotherapy Regimen Breast Cancer Chemotherapy Medical Treatment Oncologists
• ISSN:
  0027-8874
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  California ; Georgia ; Michigan ; OSHA Region 4 ; OSHA Region 5 ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  493-500
• Volume:
  110
• Issue:
  5
• NIOSHTIC Number:
  nn:20055356
• Citation:
  J Natl Cancer Inst 2018 May; 110(5):493-500
• Contact Point Address:
  Allison W. Kurian, MD, MSc, Stanford University School of Medicine, HRP Redwood Building, Room T254A, Stanford, CA 94305-5405
• Email:
  akurian@stanford.edu
• Federal Fiscal Year:
  2018
• Performing Organization:
  University of Michigan, Ann Arbor
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Journal of the National Cancer Institute
• End Date:
  20280630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:f26359dc856acc33c817e625373507d69fd542f806301f978e072ff538fe78ca44e4e76604d13cae070975b4c0c40d99542000927799590ef25f5e664b0fd10a
• Download URL:
  https://stacks.cdc.gov/view/cdc/217684/cdc_217684_DS1.pdf
• File Type:
  [PDF - 920.16 KB ]