Biomarkers in breast cancer: Quantifying discordance with best practice when hormone receptor status is an extravagance

South African Journal of Oncology

ARTICLE

Melinda Mushonga¹  Ntokozo Ndlovu¹  Anna M. Nyakabau¹  Sandra Ndarukwa-Jambwa¹  Zahra Kassam²  Webster Kadzatsa¹  Zhihui Liu³  Rebecca K.S. Wong⁵ 

[1] Department of Radiology, College of Health Sciences, University of Zimbabwe;Radiation Medicine Program, Stronach Regional Cancer Center;Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network;Dalla Lana School of Public Health, University of Toronto;Radiation Medicine Program, Princess Margaret Cancer Center;Department of Radiation Oncology, University of Toronto;Institute Health Policy Management and Evaluation, University of Toronto

关键词: breast cancer;    biomarkers;    treatment guidelines;    limited resources;    sub-Saharan Africa.;   

DOI  :  10.4102/sajo.v4i0.134

学科分类：工业工程学

来源: AOSIS

【 摘 要 】

Background: In Zimbabwe, the hormone receptor status is not always available when patients with breast cancer are started on treatment. Aim: This study evaluated the discordance of treatment approach in such patients, with National Comprehensive Cancer Network (NCCN) guideline recommendations as the reference standard when these results are eventually available. Setting: Female patients who presented to the Parirenyatwa Central Hospital Radiotherapy and Oncology Centre with a histological diagnosis of breast cancer, managed between 1 January 2014 and 31 December 2016. Methods: Patients with breast cancer having unknown receptor status at diagnosis, and the hormone receptor status were subsequently available either clinically or the tissues were available for study-specific analysis, were eligible for the study. The level of agreement between treatments received and the NCCN recommendations if the receptor status was known was tested using Kappa statistic. Results: Patients in stage I–III received treatment that were in strong agreement with the use of chemotherapy, and endocrine treatments with agreement scores of 1 (95% CI 0.91–1) and 0.81 (95% CI 0.65–0.95), respectively; but moderate agreement with regard to the choice of chemotherapy regimen, with a score of 0.5 (95% CI 0.32–0.68). There was a median delay of 8 (range 3–27) months for the availability of receptor status. Of the 38 stage IV patients, 33 (87%) were recommended chemotherapy. Of the 38 patients, 25 (66%) had hormone driven disease. There was somewhat agreement for use of chemotherapy, choice of chemotherapy regimen and use of endocrine treatments as initial choice with agreement scores of 0.53 (95% CI 0.36,0.69), 0.18 (95% CI 0.07, 0.35) and 0.68 (95% CI 0.51,0.82) respectively. Conclusion: Treatment approaches were largely in agreement with the NCCN guidelines for patients in stage I–III. Discordance was noted in stage IV patients with under-utilisation of hormone therapy as the initial treatment when the receptor status was unknown.

【 授权许可】

CC BY