Risk estimations and treatment decisions in early stage breast cancer: agreement among oncologists and the impact of the 70-gene signature.
نویسندگان
چکیده
BACKGROUND Clinical decision-making in patients with early stage breast cancer requires adequate risk estimation by medical oncologists. This survey evaluates the agreement among oncologists on risk estimations and adjuvant systemic treatment (AST) decisions and the impact of adding the 70-gene signature to known clinico-pathological factors. METHODS Twelve medical oncologists assessed 37 breast cancer cases (cT1-3N0M0) and estimated their risk of recurrence (high or low) and gave a recommendation for AST. Cases were presented in two written questionnaires sent 4 weeks apart. Only the second questionnaire included the 70-gene signature result. RESULTS The level of agreement among oncologists in risk estimation (κ=0.57) and AST recommendation (κ=0.57) was 'moderate' in the first questionnaire. Adding the 70-gene signature result significantly increased the agreement in risk estimation to 'substantial' (κ=0.61), while agreement in AST recommendations remained 'moderate' (κ=0.56). Overall, the proportion of high risk was reduced with 7.4% (range: 6.9-22.9%; p<0.001) and the proportion of chemotherapy that was recommended was reduced with 12.2% (range: 5.4-29.5%; p<0.001). CONCLUSION Oncologists' risk estimations and AST recommendations vary greatly. Even though the number of participating oncologists is low, our results underline the need for a better standardisation tool in clinical decision-making, in which integration of the 70-gene signature may be helpful in certain subgroups to provide patients with individualised, but standardised treatment.
منابع مشابه
Rapid Health Technology Assessment of Oncotype DX in Patients with Early-Stage Breast Cancer
Introduction: Breast cancer is the most common cancer in women. Patients are treated with chemotherapy initially, and if not chemically treated, the risk of recurrence of the disease increases yearly. Therefore, methods for identifying patients for whom chemotherapy would be most beneficial are very important. The Oncotype DX test is a prognostic assay that predicts the likelihood of breast can...
متن کاملبیان ژن HER4 درنمونه های بلوک پارافینه بیماران مبتلا به سرطان پستان
Background: the breast cancer is the second cause of worldwide death. Understanding of molecular pathology of breast cancer can provide useful information about new treatment routes. HER4 gene considered as a molecular pre-prognostic marker in cancers recently. So the purpose of this research is studying of HER4 gene expression in breast cancer patients. Methods: in this study 70 samples of ...
متن کاملThe Effect of Decision Aid's Pakage in Selected Treatment by Patients with Early Stage Breast Cancer and Decision making Outcomes
Background & Objectives: One of the basic principle of the protection of the patient, the patient's right to make decisions for their health. In this study, the effect of using decision aid's package was studied on choice of treatment and decision making outcomes in patients with early-stage breast cancer. Materials and Methods: This research is a clinical trial, performed on 30 patients with ...
متن کاملAssociation Between Oncotype DX Recurrence Score and Clinicopathological Variables in Breast Cancer Patients
Introduction: Breast cancer is the most common cancer and the leading cause of cancer-related death in women. Clinicopathological variables are important factors in deciding on breast cancer treatment. This study evaluated the association between the recurrence score generated by the Oncotype DX® 21-gene assay and classic clinicopathological variables. Methods: A single-institution retrospect...
متن کاملAttitude of Iranian Medical Oncologists Toward Economic Aspects, and Policy-making in Relation to New Cancer Drugs
Background Although medical oncologists can have an important role in controlling the cost of cancer treatment, there is little information about their attitudes toward the cost of cancer treatment and the impact of cost on their treatment recommendations, especially in low- and middle-income countries (LMICs). In this study, we assessed the attitude of Iranian medical oncologists toward some e...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- European journal of cancer
دوره 50 6 شماره
صفحات -
تاریخ انتشار 2014