Article type
Year
Abstract
Background: health prevention activities, screening and advances in treatments have led to an increase in survival of breast cancer (BC) patients. Side effects have been described as a consequence of surgery, radiotherapy and chemotherapy, especially when treatments are combined. Concern about potential overtreatment is well extended across clinical institutions. Cochrane produces high-quality systematic reviews (SR) to improve decision making by those providing and receiving care. The information produced could also be useful for reducing overtreatment
Objectives: to describe and compare the characteristics of BC treatment in two periods separated by five years, and to determine if the therapeutic changes implemented over time agree with Cochrane SRs that focused on BC treatment
Methods: retrospective study of a random sample of women diagnosed with BC in the years 2011 and 2016 at a tertiary hospital in Barcelona, Spain. We gathered clinical data from patients’ medical records. We searched the Cochrane library to identify SRs focused on BC that could be used to reduce BC overtreatment. We performed a comparative analysis of the two periods.
Results: the study included 105 women diagnosed with BC (51 in 2011; 54 in 2016). Mean age was 55 years. A total of 88.6% of patients had an infiltrating tumour, 47.7% of them were at early stage, I or under. The comparison about treatment characteristics between both periods revealed significant differences: an increase in the use of neo-adjuvant chemotherapy (21.6 versus 44.4%; P = 0.01), a reduction of lymph-node removal (41.9 versus 20.8%; P = 0.06), and radical surgery (43.1 versus 17.3%; P = 0.004) with a tendency to immediate reconstruction. We identified three Cochrane SRs that focused on BC treatment:
1) Preoperative chemotherapy for women with operable BC, with high- to moderate-quality evidence, concluded that preoperative chemotherapy increases breast conservation rates with fewer adverse effects;
2) Axillary treatment for operable primary BC, with moderate- to low-quality evidence, suggested that lesser axillary surgery does not have a reduced chance of survival compared with axillary lymph node dissection, and has fewer side effects; and
3) Immediate versus delayed reconstruction following surgery for BC, with very low-quality evidence, suggested that immediate reconstruction reduced psychological morbidity. Changes in BC treatment over time in our hospital agree with conclusions of the Cochrane SRs, particularly those related to chemotherapy and axillary treatment.
Conclusions: our study identifies positive changes in BC therapy over time with a more conservative approach based on the evidence concordant with the corresponding Cochrane SR. Integrating the best evidence into daily clinical practice is a good opportunity to reduce potential situations of overtreatment
Patient or healthcare consumer involvement: authors will give feedback of the results via publication of medical or lay journals and conference presentations.
Objectives: to describe and compare the characteristics of BC treatment in two periods separated by five years, and to determine if the therapeutic changes implemented over time agree with Cochrane SRs that focused on BC treatment
Methods: retrospective study of a random sample of women diagnosed with BC in the years 2011 and 2016 at a tertiary hospital in Barcelona, Spain. We gathered clinical data from patients’ medical records. We searched the Cochrane library to identify SRs focused on BC that could be used to reduce BC overtreatment. We performed a comparative analysis of the two periods.
Results: the study included 105 women diagnosed with BC (51 in 2011; 54 in 2016). Mean age was 55 years. A total of 88.6% of patients had an infiltrating tumour, 47.7% of them were at early stage, I or under. The comparison about treatment characteristics between both periods revealed significant differences: an increase in the use of neo-adjuvant chemotherapy (21.6 versus 44.4%; P = 0.01), a reduction of lymph-node removal (41.9 versus 20.8%; P = 0.06), and radical surgery (43.1 versus 17.3%; P = 0.004) with a tendency to immediate reconstruction. We identified three Cochrane SRs that focused on BC treatment:
1) Preoperative chemotherapy for women with operable BC, with high- to moderate-quality evidence, concluded that preoperative chemotherapy increases breast conservation rates with fewer adverse effects;
2) Axillary treatment for operable primary BC, with moderate- to low-quality evidence, suggested that lesser axillary surgery does not have a reduced chance of survival compared with axillary lymph node dissection, and has fewer side effects; and
3) Immediate versus delayed reconstruction following surgery for BC, with very low-quality evidence, suggested that immediate reconstruction reduced psychological morbidity. Changes in BC treatment over time in our hospital agree with conclusions of the Cochrane SRs, particularly those related to chemotherapy and axillary treatment.
Conclusions: our study identifies positive changes in BC therapy over time with a more conservative approach based on the evidence concordant with the corresponding Cochrane SR. Integrating the best evidence into daily clinical practice is a good opportunity to reduce potential situations of overtreatment
Patient or healthcare consumer involvement: authors will give feedback of the results via publication of medical or lay journals and conference presentations.
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