Adjuvant! Online does not significantly influence adjuvant chemotherapy decisions of a breast cancer multidisciplinary team (MDT): a prospective study.

One of the most difficult tasks of a breast cancer multidisciplinary team (MDT) is to decide on the need for adjuvant chemotherapy (CT) in patients with invasive breast carcinoma. While the need for adjuvant endocrine therapy is largely determined by a single factor (hormone receptor positivity), the need for adjuvant CT is determined by multiple factors such as patient age, tumour size, grade, node positivity and hormone receptor and human epidermal receptor growth factor-2 receptor status. The UK National Institute for Health and Clinical Excellence (NICE) recommends using Adjuvant! Online, an online computer programme that allows quantitative estimates of the effect of adjuvant CT on the 10year risk of death and relapse in the MDT decision-making process [1]. The majority of breast oncologists use Adjuvant! Online in their clinical practise [2], however we previously reported in a retrospective study [3] that the use of Adjuvant! Online in an MDT did not change the management in the majority of cases. In this audit we prospectively studied the impact of Adjuvant! Online-derived numerical estimates of CT benefit on the MDT decision-making process. We studied 109 early breast cancer patients discussed in 41 MDT meetings over 12 months. All had unilateral, unicentric, invasive adenocarcinoma and had undergone breast surgery and axillary node staging. Patients who had neoadjuvant therapy or