Quality of adjuvant chemotherapy in primary breast cancer in a non-trial setting. A comprehensive cancer centre study

The quality of adjuvant chemotherapy with cyclophosphamide, methotrexate an d 5-fluorouracil (CMF) and the compliance with guidelines for this treatmen t were studied in 323 premenopausal patients with node positive breast canc er, who were treated in the Comprehensive Cancer Centre East of The Netherl ands (IKO) from 1988 to 1992, outside the setting of a clinical trial. The interval surgery-chemotherapy, the duration of chemotherapy, dose intensity (DI) and relative dose intensity (RDI) of CMF chemotherapy and validations of dose modifications were evaluated. 295 of 323 patients (91%) received a djuvant chemotherapy, CMF chemotherapy was used in 230 patients (78% of the chemotherapy receiving patients). The median time to the start of chemothe rapy was 62 (range-35-139) days after surgery. Forty-two per cent of the pa tients finished their CMF chemotherapy within 168 days. Two per cent of the patients did not finish the six courses of CMF chemotherapy. The mean DI a nd RDI of the eligible patients in all CMF using hospitals were: 80.4+/-28. 8% and 78.2+/-28.4%, respectively. Aberrations of recommended guideline pro cedures resulted more often in suboptimal treatment than haematological tox icity. Adherence to the guidelines was variable and resulted in suboptimal adjuvant chemotherapy. The median follow-up of the patients treated in hosp itals that agreed to the use of CMF was 5 years. The mean RDI of CMF in the eligible patients who relapsed was 72.2+/-32.7%, compared with 81.4+/-25.2 % for the patients who did not relapse (P0.01), suggesting a possible influ ence of the RDI on disease free survival. However, when the patients who di d not receive chemotherapy were excluded, the mean RDI of the patients who relapsed was 85.0+/-12.6% and of the patients who did not relapse 87.4+/-12 .6%, which was not significantly different (P=0.20). (C) 1999 Elsevier Scie nce Ltd. All rights reserved.