加拿大乳腺癌新辅助治疗国家专家共识：将实践与证据及其他方面联系起来。
A Canadian national expert consensus on neoadjuvant therapy for breast cancer: linking practice to evidence and beyond.
作者信息
Simmons C E, Hogeveen S, Leonard R, Rajmohan Y, Han D, Wong A, Lee J, Brackstone M, Boileau J F, Dinniwell R, Gandhi S
机构信息
Division of Medical Oncology, BC Cancer Agency, Vancouver, BC.
Division of Medical Oncology, St. Michael's Hospital, Toronto, ON.
出版信息
Curr Oncol. 2015 Mar;22(Suppl 1):S43-53. doi: 10.3747/co.22.2328.
BACKGROUND
Use of the neoadjuvant approach to treat breast cancer patients has increased since the early 2000s, but the overall pathway of care for such patients can be highly variable. The aim of our project was to establish a multidisciplinary consensus among clinicians with expertise in neoadjuvant therapy (nat) for breast cancer and to determine if that consensus reflects published methods used in randomized controlled trials (rcts) in this area.
METHODS
A modified Delphi protocol, which used iterative surveys administered to 85 experts across Canada, was established to obtain expert consensus concerning all aspects of the care pathway for patients undergoing nat for breast cancer. All rcts published between January 1, 1967, and December 1, 2012, were systematically reviewed. Data extracted from the rcts were analyzed to determine if the methods used matched the expert consensus for specific areas of nat management. A scoring system determined the strength of the agreement between the literature and the expert consensus.
RESULTS
Consensus was achieved for all areas of the pathway of care for patients undergoing nat for breast cancer, with the exception of the role of magnetic resonance imaging in the pre-treatment or preoperative setting. The levels of agreement between the consensus statements and the published rcts varied, primarily because specific aspects of the pathway of care were not well described in the reviewed literature.
CONCLUSIONS
A true consensus of expert opinion concerning the pathway of care appropriate for patients receiving nat for breast cancer has been achieved. A review of the literature illuminated gaps in the evidence about some elements of nat management. Where evidence is available, agreement with expert opinion is strong overall. Our study is unique in its approach to establishing consensus among medical experts in this field and has established a pathway of care that can be applied in practice for patients receiving nat.
背景
自21世纪初以来，新辅助治疗方法在乳腺癌患者中的应用有所增加，但此类患者的整体护理路径可能差异很大。我们项目的目的是在乳腺癌新辅助治疗（nat）方面具有专业知识的临床医生之间达成多学科共识，并确定该共识是否反映了该领域随机对照试验（rcts）中使用的已发表方法。
方法
建立了一种改良的德尔菲协议，通过对加拿大85位专家进行反复调查，以获得关于接受乳腺癌nat治疗患者护理路径各方面的专家共识。对1967年1月1日至2012年12月1日期间发表的所有rcts进行了系统评价。对从rcts中提取的数据进行分析，以确定所使用的方法是否与nat管理特定领域的专家共识相匹配。一个评分系统确定了文献与专家共识之间的一致程度。
结果
除磁共振成像在治疗前或术前阶段的作用外，对于接受乳腺癌nat治疗患者的护理路径所有领域均达成了共识。共识声明与已发表的rcts之间的一致程度各不相同，主要是因为护理路径的具体方面在综述文献中没有得到很好的描述。
结论
已就适合接受乳腺癌nat治疗患者的护理路径达成了专家意见的真正共识。对文献的综述揭示了nat管理某些要素证据方面的差距。在有证据的地方，总体上与专家意见的一致性很强。我们的研究在该领域医学专家之间建立共识的方法上是独特的，并建立了一条可应用于接受nat治疗患者实践的护理路径。
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