Multidisciplinary Management Decisions for Newly Diagnosed Breast Cancer Patients: Our Practice in Relation to Clinical Guidelines

Purpose: Multidisciplinary care describes an integrated team approach to health care. We aimed to review the management decisions of newly diagnosed breast cancer (BC) patients presented to our breast cancer multidisciplinary team (BCMDT) meetings in relation to the commonly adopted clinical guidelines. Methods: Retrospective review of BCMDT meetings records from 01 March 2013 to 31 of July 2013 in the City General Hospital, Stoke-on-Trent, UK. Results: There were 117 BC patients; 2 of them were males. The median age at diagnosis was 51 years (range 29- 82). Stage II was most common (40.2%). Invasive ductal carcinoma was diagnosed in 68.4%, invasive lobular carcinoma in 18.8% and ductal carcinoma in situ (DCIS) in 12.8%. HER2/neu testing was positive in 20.6%. Sixty four patients (55%) had breast conserving surgery (BCS); 36 (30.6%) had mastectomy and 17 (14.4%) had no surgical treatment. Eighty nine patients had axillary surgery; 23 (25.8%) had sentinel lymph node biopsy (SLB) and 66 (74.2%) had axillary clearance from the start due to clinical lymphadenopathy. Neoadjuvant chemotherapy/hormonal treatment was recommended in 40 patients with stages II-III BC for either unresectable advanced BC (17 patients, 42%); BCS (21 patients, 53%) or triple negative BC (2 patients, 5%). Adjuvant chemotherapy and/or hormonal treatment wererecommended in 47 patients with invasive BC. Nottingham prognostic index (NPI) and adjuvant online! website were used to guide the choice of systemic adjuvant treatment in 57.4% and 42.6% of patients respectively. FEC-D (fluorouracil, epirubicin, cyclophosphamide, docetaxel) ± trastuzumab was the most commonly recommended regimen both in the neo-adjuvant (82.5%) and adjuvant (74%) settings. For DCIS patients, the Van Nuys Prognostic Index (VNPI) was used to guide decisions of adjuvant radiotherapy (ART) following BCS. Accordingly 60% were recommended ART (VNPI 7-9) and 40% completion mastectomy (VNPI 10-12). Adjuvant radiotherapy was recommended in 79% of BC cases. Adjuvant tamoxifen and/or aromatase inhibitors were recommended for a total of 10 years for patients with Oestrogen and/or progesterone receptors breast cancer. Fluorouracil, epirubicin and cyclophosphamide (FEC) regimen was the most commonly recommended palliative regimen (40%) in patients who had metastatic BC at their first presentation. Genetic referral was arranged for 17% of our patients. Conclusion: Although standardisation of guidelines is required, the use of personalised medicine should also be encouraged.