Journal of Clinical Oncology, Vol 12, 1422-1426, Copyright © 1994 by American Society of Clinical Oncology
Do American oncologists know how to use prognostic variables for patients with newly diagnosed primary breast cancer?
CL Loprinzi, PM Ravdin, M de Laurentiis and P Novotny
Division of Medical Oncology, Mayo Clinic, Rochester, MN 55905.
PURPOSE: This project was designed to investigate how American medical
oncologists actually use prognostic information to treat primary breast
cancer patients, and to study their difficulties in combining complex and
sometimes contradictory information. METHODS: A simple 2-page questionnaire
was faxed in May and June 1993 to a sample of American medical oncologists
who were members of the American Society of Clinical Oncology (ASCO).
RESULTS: When presented with simple case histories of patients with newly
diagnosed invasive breast cancer and asked to assess prognosis on the basis
of tumor size, number of involved axillary nodes, patient age, estrogen
receptor level, and progesterone receptor level, there was a wide
divergence of opinions about the probability of disease-free survival at 10
years (both for cases in which the patient received no adjuvant therapy and
for those in which the patient did receive such therapy). The use of
additional prognostic data (such as S-phase, tumor histologic and nuclear
grading, and cathepsin D status) did not refine the estimates, but led to
an equal or greater dispersion of estimates of prognosis. CONCLUSION: There
is a clear need for tools to help oncologists integrate prognostic
information for primary breast cancer patients. Such tools might lead to
greater accuracy and uniformity of prognostic estimates. Such tools might
also help make clear what prognostic tests are worth using for routine
clinical practice.
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