APPROPRIATENESS OF ADJUVANT SYSTEMIC THERAPY FOR AXILLARY NODE-NEGATIVE BREAST-CANCER - A PHYSICIAN OPINION SURVEY

Purpose: To examine variations in physicians' recommendations for syst emic adjuvant therapy in the treatment of women with node negative bre ast cancer (NNBC) and to determine factors used in making specific rec ommendations. Materials and Methods: A questionnaire wets sent by mail to all 149 Ontario physicians who actively treated breast cancer in 1 993, The questionnaire described 48 clinical scenarios of women with N NBC, which included all possible combinations of the following factors : menopausal status, tumor size, hormone receptor status, histologic a nd nuclear grade, and lymphatic and/or vascular invasion, Respondents rated the appropriateness of administering tamoxifen, combination chem otherapy, or both tamoxifen and combination chemotherapy on a nine-poi nt scale from extremely inappropriate to extremely appropriate, Respon dent agreement and disagreement were tabulated for each scenario, and factors associated with specific treatment ratings were analyzed by lo gistic regression. Results: The response rate was 87%, Agreement for t he appropriateness of specific therapies was most evident where clinic al trials have demonstrated efficacy, whereas disagreement was observe d in scenarios in which support for a specific treatment is not availa ble in the current literature, Relevant tumor- and patient-specific fa ctors were used in decision-making; personal characteristics of the re spondents had no statistically significant impact on appropriateness r atings. Conclusion: The physicians surveyed had good knowledge NNBC pr ognostic factors, but held a range of opinion on optimal therapy for m any clinical scenarios, which reflects current knowledge of the benefi ts of adjuvant therapy for NNBC. (C) 1995 by American Society of Clini cal Oncology.