Adjuvant chemotherapy in node negative breast cancer: Patterns of use and oncologists' preferences

Background: A worldwide variation in policy is seen regarding adjuvant systemic treatment for node negative breast cancer (NNBC). After the first presentations of the 10-year EBCTCG results, a study was carried out in the Netherlands to assess patterns of care and to obtain the views of oncologists as to what constitutes a worthwhile benefit from treatment. Methods: A questionnaire regarding patterns of use of and preferences for adjuvant chemotherapy in younger women was mailed to surgical, medical and radiation oncologists in the Netherlands. Results: Thirty-five percent stated that NNBC patients under 50 in their hospital never received adjuvant chemotherapy. The majority considered a 10-year survival gain of 6%-10% sufficient to warrant the use of chemotherapy in patients under 50. Surgical oncologists required a larger benefit from treatment than radiotherapists and medical oncologists. The more frequently oncologists treated patients in a research context, the less benefit they required from treatment to make it worthwhile. Conclusions: Data such as these are valuable input into the process of guideline development, and may help discussion within the profession as to what benefit offsets the burden of treatment.