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Researchers find decline in chemotherapy use for breast cancers

In a growing movement toward targeted, less-toxic cancer therapies, physicians are growing increasingly less likely to recommend chemotherapy treatment in some early-stage breast cancer patients, according to a study published today in the Journal of the National Cancer Institute.

Stanford cancer geneticist Allison Kurian, MD, collaborated with researchers at the University of Michigan, including cancer specialist Steven Katz, MD, to conduct the research, which found an overall decline in the use of chemotherapy for some early-stage breast cancer patients from 34.5 percent to 21.3 percent over a two-year period despite any changes in national treatment guidelines.

From our release:

The findings reflect a growing acknowledgment by oncologists and patients that for some women, the harms of chemotherapy may outweigh its potential benefits. The study also revealed that physicians are more likely to turn to tumor genomic testing when a patient expresses a treatment preference that doesn’t match her physician’s recommendations.

The researchers surveyed more than 3,000 women with early-stage breast cancer and 500 oncologists between 2013 and 2015. The women were asked if their physicians recommended chemotherapy and whether or not they received chemotherapy as part of their treatment. During the study period, the participants reported a decline in chemotherapy recommendations by their oncologists, from 44.9 percent in 2013 to 31.6 percent in 2015.

Oncologists were asked whether and when they would recommend genetic testing of a patient's tumor when deciding on a course of treatment. They found that 67.4 percent of oncologists surveyed indicated they would order tumor genomic testing to estimate a lymph node-positive woman’s risk of cancer recurrence if the woman disagreed with her doctor’s recommendation to receive chemotherapy. In contrast, only 17.5 percent would order the test if the patient and doctor were in agreement about her course of treatment.

As Kurian explained:

We believe this study indicates that physicians are attempting to be more selective in their recommendations and to spare patients toxicity when possible. As personalized medicine becomes more widely available, doctors are using test results as part of their dialogue with patients about their preferences and overall treatment goals. But the long-term outcomes of these recent changes in chemotherapy use are uncertain.

Previously: Genetic tests for  breast cancer underused, misunderstood, say researchersWomen "undertested" for breast cancer mutations, say Stanford researchers and Breast cancer patients are getting more bilateral mastectomies--but not any survival benefit
Photo of Allison Kurian by Steve Fisch

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