School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
Trials Coordination Department, Australia and New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia.
Intern Med J. 2016 Jun;46(6):677-83. doi: 10.1111/imj.13049.
Neoadjuvant systemic therapy (NAST) has become an established treatment option for women with operable breast cancer.
We aimed to better understand NAST treatment patterns, barriers and facilitators in Australia and New Zealand.
We undertook a cross-sectional survey of the current clinical practice of Australian and New Zealand breast cancer specialists. Questions included referral patterns for NAST, patient selection, logistics, decision making and barriers.
Of 207 respondents, 162 (78%) reported routinely offering NAST to selected patients with operable breast cancer (median 9% of patients offered NAST). Specialty, location, practice type, gender or years of experience did not predict for offering NAST. In all, 45 and 58% wanted to increase the number of patients who receive NAST in routine care and in clinical trials respectively. Facilitators included the multidisciplinary team meeting and access to NAST clinical trials. Specialist-reported patient barriers included: patient desire for immediate surgery (63% rated as important/very important); lack of awareness of NAST (50%); concern about progression (43%) and disinterest in downstaging (32%). Forty-three per cent of participants experienced system-related barriers to the use of NAST, including other clinicians' lack of interest (27%); lack of clinical trials (24%) and unacceptable wait for a medical oncology appointment (37%).
This group of Australian and New Zealand clinicians are interested in NAST for operable breast cancer in routine care and clinical trials. Patient- and system-related barriers that prevent the optimal uptake of this treatment approach will need to be systematically addressed if NAST is to become a more common approach.
新辅助全身治疗（NAST）已成为可手术乳腺癌患者的一种既定治疗选择。
我们旨在更好地了解澳大利亚和新西兰 NAST 治疗模式、障碍和促进因素。
我们对澳大利亚和新西兰乳腺癌专家的当前临床实践进行了横断面调查。问题包括 NAST 的转诊模式、患者选择、后勤、决策和障碍。
在 207 名受访者中，162 名（78%）报告常规向选定的可手术乳腺癌患者提供 NAST（中位数为 9%的患者接受 NAST）。专业、地点、实践类型、性别或经验年限均不能预测提供 NAST。总的来说，45%和 58%的人希望分别在常规护理和临床试验中增加接受 NAST 的患者数量。促进因素包括多学科团队会议和获得 NAST 临床试验。专家报告的患者障碍包括：患者对立即手术的渴望（63%评为重要/非常重要）；缺乏对 NAST 的认识（50%）；对进展的担忧（43%）和对降期不感兴趣（32%）。43%的参与者在使用 NAST 方面遇到了与系统相关的障碍，包括其他临床医生缺乏兴趣（27%）；缺乏临床试验（24%）和无法接受预约肿瘤内科医生的等待时间（37%）。
这群澳大利亚和新西兰临床医生对常规护理和临床试验中的可手术乳腺癌的 NAST 感兴趣。如果要使 NAST 成为更常见的治疗方法，则需要系统地解决防止这种治疗方法最佳应用的患者和系统相关障碍。
