Background and aim
Adjuvant therapy for breast cancer is routinely discussed and recommended in multidisciplinary meetings (MDMs). Current literature explores how treatments received by patients differ from national guidelines. Treatment received is a combination of a treatment being recommended and a patient following the recommendation. The latter aspect has received little attention. This study investigates the concordance between MDM recommendations and treatment actually received.
A retrospective cohort study of patients diagnosed with breast cancer at Royal Melbourne Hospital in 2010 and 2014 was conducted. Patient information was collected from medical records. Concordance was defined as initial reception of treatment e.g. attending a radiotherapy/chemotherapy appointment or accepting a script for endocrine therapy. Compliance during treatment regime was not considered.
382 patients were included in the study (151 from 2010, 231 from 2014). Overall, concordance between recommended and received treatment was 85% (CI 82%-88%). It was highest for chemotherapy (Cohen’s Kappa k=85% CI 79%-92%), followed by endocrine therapy (k=79% CI 77%-82%) and radiotherapy (k=79% CI 75%-83%). There were no significant differences in concordance between those diagnosed in 2010 as compared to 2014, however there were significant changes in treatment recommendations, including a significant decrease in recommendations for radiotherapy (74% vs 62% p=0.0115). For the patients for whom suitable information was available, non-concordance with recommendations was commonly due to a change of surgical treatment, patient comorbidities or patient choice. There were also a large number of unknown reasons for non-concordance, particularly for chemotherapy and endocrine therapy.
Although uptake of MDM recommended treatments is high, there is a minority of patients in whom MDM recommendations are not followed for a variety of reasons. More attention to this group and the reasons for non-concordance warrant further study.