312 - Correlation between decision-making tools and chemotherapy uptake in node-negative endocrine receptor early-stage breast cancer in mid-Western Ireland

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Breast Cancer, Early Stage
Bioethics, Legal, and Economic Issues
Presenter Keith Quintyne
Authors K.I. Quintyne1, B. Woulfe2, J.C. Coffey3, R.K. Gupta2
  • 1Mid-western Cancer Centre, Mid-Western Regional Hospital (MWRH), Limerick/IE
  • 2Mid-western Cancer Centre (mwcc), Mid-Western Regional Hospital (MWRH), Limerick/IE
  • 3Department Of Surgery, Mid-Western Regional Hospital (MWRH), Limerick/IE

Abstract

Background

Good clinical judgement remains the best tool in determining a therapeutic plan; however this process has become easier, and more reproducible with the ongoing progression of decision-making adjuncts such as: Nottingham Prognostic Index (NPI), which incorporates pathological features; Adjuvant! Online (AO), which incorporates clinic-pathological features; and Oncotype Dx ® Recurrence Score (RS) assay, which incorporates genetic features. We herein report our experience with the use of these tools, and their potential impact on chemotherapy uptake for patients in MWRH, Limerick, Ireland.

Methods

Study period: 01/09/2008 – 31/12/2012. Data was derived from (1) MWCC Oncology database (2) pathology reports (3) patient files (4) RS assay reports. Data was collated and entered into an Access database and exported into SPSS (v.18) for analysis. Results Seventy-seven (77) patients with early stage endocrine positive breast cancer were analysed. Median age: 55.9 years (range: 30.6 – 72.3 years). Median follow-up: 20.9 months. Findings are shown below in tabular form. 312: Table:

Chemotherapy uptake within MWRH

Decision-making tools (DMT) Chemotherapy Uptake
Offered Undertaken Not offered
Nottingham Prognostic Index (NPI) · Excellent (≤ 2.40) · Good (2.41 – 3.40) · Moderate (3.41 – 5.40) · Poor (≥ 5.41) 2/7 16/41 21/29 0/0 1/7 13/41 21/29 0/0 5/7 25/41 8/29 0/0
Adjuvant! Online (AO) – additional 10-year survival benefit of chemotherapy and hormonal therapy · 0.0 – 2.5% · 2.6 – 5.0% · 5.1 – 7.5% · ≥ 7.5% 8/21 12/33 9/13 10/10 6/21 10/33 9/13 10/10 13/21 21/33 4/13 0/10
Oncotype Dx Recurrence Score (RS) Assay · Low (1–17) · Intermediate (18 – 30) · High (>31) 13/38 20/33 6/6 11/38 18/33 6/6 25/38 13/33 0/6

Conclusions

Chemotherapy uptake from the decision-making tools was varied within the cohort, but it was uniformly noted that patients were more likely to undertake chemotherapy if they had higher indices derived from these DMT, except in cases where the patients declined therapy, or if physicians' preference differed on clinical grounds. This highlights that none of the available DMT are perfect in isolation, but when used in concert, they can elucidate the best potential treatment pathway following consultation between patients and their healthcare providers; this is given by the fact that they all rely on different subsets of information to predict potential outcome. Further work is needed to find an algorithm that can appropriately incorporate these DMT any potential patient's best interest.

Disclosure

All authors have declared no conflicts of interest.