Challenges in optimizing care in advanced breast cancer patients: Results of an international survey linked to the ABC1 consensus conference

Abstract

Until recently, many international guidelines have focussed on the treatment of early-stage breast cancer, with little emphasis on advanced-stage disease. To improve the management of advanced breast cancer (ABC), the European School of Oncology (ESO) established the ABC International Consensus Conference and Guidelines. Delegates from the first conference and additional groups selected by ESO were invited to complete a survey to identify current challenges and barriers associated with optimizing ABC management. 609 Respondents from 78 countries completed the questionnaire. "Lack of clear and applicable management guidelines" and "lack of high-level evidence for treatment options" were identified as key barriers to raising the profile of ABC and treating the disease. The survey also revealed a lack of multidisciplinary treatment, specialized ABC nurses, and routine psychosocial support in clinical practice. Implementing high-quality guidelines could lead to better practice in the management of ABC by encouraging multidisciplinary treatment and patient-support initiatives.

A survey by the European Society of Breast Imaging on the utilisation of breast MRI in clinical practice

“…The evaluation of the response to treatment and screening of high-risk women are less frequent indications in eastern countries. This latter might reflect the current lack of organised high-risk screening programs but both may also be connected to cost-issues in situations where potential clinical effects are not immediately perceived [ 14 , 15 ].…”

“…This survey specifically targeted EUSOBI members and is, therefore, potentially biased towards radiologists with a special interest in breast imaging. As is typical for surveys, the response rate was below 50% [ 14 , 15 ]. Participants were not evenly distributed among European countries, a fact that is also attributable to the distribution of members within the society, with the best-represented countries being Italy, the Netherlands, and United Kingdom, while other countries such as Germany and France are less represented within the EUSOBI.…”

The Epidemiological Challenges of Breast Cancer among Premenopausal Women in Limited Resource Settings

“…Although representatives of various countries at the 2002 Seattle Conference recommended early detection, diagnosis, and treatment, as well as the adoption of guidelines that emphasize the actions in each disease stage and phase, these recommendations have not been universally adopted within healthcare systems. For some systems, this is due to the shortage of resources, low availability of trained professionals, and cultural, ethnic, and environmental differences (urban, rural, and social stratification), which limit opportunities for access and detection [82][83][84][85] .…”

“…These countries likewise confront problems with social crises, political insecurity, war, and combinations of these factors that derail and obstruct healthcare, including efforts at early breast cancer detection. In these countries, it is necessary to include a strategic agenda for the control and care of this disease to improve breast cancer survival [82][83][84][85] . In the case of Latin America, many countries in the region have standards of care and programs for breast cancer detection and medical attention.…”

Assessment of the prognostic role of a 94-single nucleotide polymorphisms risk score in early breast cancer in the SIGNAL/PHARE prospective cohort: no correlation with clinico-pathological characteristics and outcomes

“…Clinico-pathological criteria, including patient age, axillary lymph node involvement, tumor size and Scarff-Bloom-Richardson (SBR) grade, are commonly used in the clinical routine as breast cancer prognostic factors; estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status are validated as prognostic and predictive factors [ 9 – 11 ]. Based on these predictive factors, medical oncologists divide breast cancers into 3 categories according to the management they require [ 12 , 13 ]: (1) HER2-positive breast cancers are characterized by amplification of the HER2 gene (human epidermal growth factor receptor 2, located at 17q12) associated with gene overexpression and consequently high abundance of HER2 protein. The advent of trastuzumab, a humanized monoclonal antibody specifically targeting the HER2 extracellular domain, has revolutionized the natural history and management of HER2-positive breast cancers [ 14 ]; (2) triple-negative breast cancer, with no expression of ER or PR and no HER2 overexpression (amplification) has overall poorer prognosis than other subtypes and requires chemotherapy [ 15 ]; (3) HER2-negative breast cancers with ER or PR expression represent the third group, called luminal breast cancers, and are usually treated with endocrine therapy [ 16 ].…”