Computer program to assist in making decisions about adjuvant therapy for women with early breast cancer

Purpose: The goal of the computer program Adjuvant! is to allow health prof essionals and their patients with early breast cancer to make more informed decisions about adjuvant therapy. Methods: Actuarial analysis was used to project outcomes of patients with a nd without adjuvant therapy based on estimates of prognosis largely derived from Surveillance, Epidemiology, and End-Results data and estimates of the efficacy of adjuvant therapy based on the 1998 overviews of randomized tri als of adjuvant therapy. These estimates can be refined using the Prognosti c Factor Impact Calculator, which uses a Bayesian method to make adjustment s based on relative risks conferred and prevalence of positive test results . Results: From the entries of patient information (age, menopausal status, c omorbidity estimate) and tumor staging and characteristics (tumor size, num ber of positive axillary nodes, estrogen receptor status), baseline prognos tic estimates are made. Estimates for the efficacy of endocrine therapy (5 years of tamoxifen) and of polychemotherapy (cyclophosphamide/methotrexate/ fluorouracil-like regimens, or anthracyclinebased therapy, or therapy based on both an anthracycline and a taxane) can then be used to project outcome s presented in both numerical and graphical formats. Outcomes for overall s urvival and disease-free survival and the improvement seen in clinical tria ls, are reasonably modeled by Adjuvantl, although an ideal validation for a ll patient subsets with all treatment options is not possible. Additional s peculative estimates of years of remaining life expectancy and long-term su rvival curves can also be produced. Help files supply general information a bout breast cancer. The program's Internet links supply national treatment guidelines, cooperative group trial options, and other related information. Conclusion: The computer program Adjuvantl can play practical and education al roles in clinical settings.