2P - Agreement in risk assessment among breast cancer specialists: A survey within the MINDACT cohort

Date 07 May 2015
Event IMPAKT 2015
Session Welcome reception and Poster Walk
Topics Bioethics, Legal, and Economic Issues
Breast Cancer
Presenter Caroline Drukker
Citation Annals of Oncology (2015) 26 (suppl_3): 1-3. 10.1093/annonc/mdv113
Authors C. Drukker1, L. Slaets2, R. Goossens3, M. Schmidt4, E.J. Rutgers5, F.C. Cardoso6, S. Linn7, J. Bogaerts2
  • 1Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, 1066 CX - Amsterdam/NL
  • 2Statistics, EORTC HQ, 1200 - Brussels/BE
  • 3Data Management, EORTC HQ, 1200 - Brussels/BE
  • 4Division Of Molecular Pathology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, 1066 CX - Amsterdam/NL
  • 5Department Of Surgery, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, 1066 CX - Amsterdam/NL
  • 6Breast Unit, Champalimaud Foundation Cancer Center, 1400-038 - Lisboa/PT
  • 7Medical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, 1066 CX - Amsterdam/NL

Abstract

Body

Background: Clinical guidelines were designed to guide breast cancer (BC) specialists in their decision whether or not to administer adjuvant chemotherapy (aCT) to the individual patient. The aim of this survey is to evaluate to which extent BC specialists agree on risk and aCT administration, whether this is in line with an Adjuvant! Online based risk-cut off used in the Mindact control arm (AOL-M), and in which combinations of clinical / pathological features the (dis)agreement is present. We intend to use this information in fine tuning the analysis of the MINDACT results.

Methods: Eighty-two BC specialists assessed 40 BC cases from the MINDACT trial, estimated their risk of recurrence (high or low) and gave a recommendation for aCT. Cases were presented in an online questionnaire with random reordering of cases between participants. The agreement among the BC specialists as well as the agreement with AOL-M was evaluated. For each case, the agreement among BC specialists was measured as the frequency of the most frequent assessment for that case (range= 50% (complete disagreement) to 100% (perfect agreement)) and the agreement with the AOL-M as the amount of assessments that are the same as AOL-M (range = 0% (complete disagreement) to 100% (perfect agreement)). The overall agreement is the weighted average of the case-agreements by both agreement types.

Results: Most participants were medical oncologist (78%), with at least 10 years of experience (76%). Each case was evaluated by 71 to 76 participants (median 73). The overall agreement among participants on the risk of recurrence and the administration of aCT was moderate (77%), but varied from case to case (range 53% to 100%). The overall agreement between the participants and AOL-M was low (64%), with a lot of variation across cases (range 5% to 100%). We will further map the areas of patient characteristics that carry most of the disagreement, and investigate whether gene signatures can help in addressing the lack of consensus by the time of the meeting.

Conclusion: Preliminary conclusions are that the agreement among breast cancer specialists regarding the risk of recurrence and administration of aCT as well as the agreement with the Mindact AOL based control arm is low to moderate.

Clinical trial identification: NCT00433589

Disclosure: All authors have declared no conflicts of interest.