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Poster display session

2284 - Enhancing decision-making about adjuvant chemotherapy in ER+, HER2- early breast cancer (EBC) following EndoPredict testing

Date

11 Sep 2017

Session

Poster display session

Topics

Cytotoxic Therapy;  Breast Cancer

Presenters

Lesley Fallowfield

Citation

Annals of Oncology (2017) 28 (suppl_5): v43-v67. 10.1093/annonc/mdx362

Authors

L. Fallowfield1, S. May1, L. Matthews1, V. Jenkins1, J. Mackay2, A. Arbon3, B. Hack3, J. Hall4, C. Harper-Wynne5, S. Hinde6, A. Moss7, E. Thanopoulou8, S. Westwell9, D. Wlaszly3, R. Simcock3, G. Patel3, D. Bloomfield3

Author affiliations

  • 1 Shore-c/bsms, University of Sussex, BN1 9RX - Brighton/GB
  • 2 Oncology, University College London Cancer Institute, WC1E6BT - London/GB
  • 3 Oncology, Brighton&Sussex University Hospitals, BN2 - Brighton/GB
  • 4 Oncology, Dartford & Gravesham NHS Trust, Dartford/GB
  • 5 Oncology, Kent Oncology Centre, Maidstone/GB
  • 6 Centre For Health Economics, University of York, York/GB
  • 7 Oncology, Western Sussex Hospitals NHS Foundation, Worthing/GB
  • 8 Oncology, Surrey and Sussex HEalthcare NHS Trust, Redhill/GB
  • 9 Oncology, East Sussex Healthcare NHS Trust, Eastbourne/GB
More

Resources

Abstract 2284

Background

Chemotherapy side-effects can be substantial. There is increasing recognition that with surgery, radiotherapy and hormone treatment (tmt), many patients (pts) derive no benefit from chemotherapy and experience only iatrogenic harm. Gene expression profiling tests can help refine recurrence risk and likely chemotherapy benefit. EndoPredict is a multigene test which includes clinico-pathologic parameters to produce an EPclin score classifying risks of distant recurrence as low or high for ER+ve HER2–ve pts treated with adjuvant endocrine tmt alone. We compared tmt decisions pre and post EndoPredict test results, pts’ anxiety, decisional conflict and oncologists’ confidence about decisions made.

Methods

14 oncologists in 7 UK hospitals saw 149 pts judged to have equivocal indications for chemotherapy. Pts and oncologists discussed provisional tmt decisions based on usual prognostic factors. These decisions were reconsidered when EPclin results were available. Pre and post-test pts completed Spielberger’s State/Trait Anxiety inventory (STAI) and a decision conflict scale (DCS). Oncologists additionally recorded:- basic clinical details, their agreement with, and confidence about tmt decisions (endocrine (E) therapy +/- chemotherapy(C)).

Results

66.7% pts with an initial E alone decision and a high risk result upgraded to E+C. 9.4% pts with initial E+C decisions and high risk results down-graded to E alone. None of 46 pts initially favouring E alone who were low risk changed decisions. 82.8% who initially wanted E+C and had low risk scores downgraded to E alone. Endopredict results increased oncologists’ confidence (8% ‘strongly agreed’ pre-test, 50% post-test). Oncologists neither agreeing nor disagreeing with decisions fell (24% to 5%). Anxiety was stable in pts with unchanged decisions. Pts whose tmt was downgraded had significantly lower anxiety scores (p 

Conclusions

EndoPredict scores increased oncologists’ and pts’ decision-making confidence, generally improved the matching of risk with therapy decisions.

Clinical trial identification

ISRCTN69220108

Legal entity responsible for the study

David Bloomfield

Funding

Myriad Genetics

Disclosure

L. Fallowfield, D. Bloomfield: Educational grant from Myriad Genetics. J. Mackay: Consultancy role to Myriad Genetics and travel expenses. S. Hinde: Educational grant from Myriad Genetics. A. Moss: Consultancy for Myriad Genetics. All other authors have declared no conflicts of interest.

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