A qualitative study to evaluate physician attitudes regarding omission of surgery among exceptional responders to neoadjuvant systemic therapy for breast cancer (NRG-CC006)

Laila A. Gharzai, Lauren A. Szczygiel, Dean A. Shumway, Hanna Bandos, Thomas B. Julian, Eleftherios P. Mamounas, Julia White, Jennifer F. De Los Santos, Mark Basik, Patricia A. Ganz, Reshma Jagsi*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Accrual to clinical trials that challenge well-established treatment paradigms represents a unique challenge. Physician opinions on investigation of a novel approach to breast cancer treatment, in which patients with complete response to neoadjuvant chemotherapy are offered omission of lumpectomy, are unknown. NRG-CC006 sought to describe physician attitudes toward a novel approach to breast cancer treatment. Methods: We recruited 18 participants in the fields of surgery, medical oncology, and radiation oncology to participate in the semi-structured telephone interviews. Main outcomes are qualitative themes associated with omission of surgery. Results: Of 18 interview participants, specialty and gender were evenly represented across surgery, medical oncology, and radiation oncology. Qualitative themes included general attitudes toward treatment de-escalation, stakeholder considerations, and trial/protocol considerations. The vast majority of participants expressed interest in investigation of omission of surgery, with all participants endorsing need for further investigation into treatment de-escalation. Stakeholder considerations in opening such a trial emphasized need for multidisciplinary involvement and, particularly, the unique role of surgeons as gatekeepers in breast cancer treatment. Finally, participants endorsed a need for further foundational studies to develop ways to predict complete pathologic response to chemotherapy without surgical intervention. Conclusions: Physicians expressed interest in investigating a novel approach to breast cancer treatment that would omit surgery in complete responders to neoadjuvant chemotherapy. Multidisciplinary input, and specifically surgeon engagement, will be key to the success of future investigations. Ongoing work to develop approaches to predict pathologic complete response accurately is needed to achieve the promise of this idea. ClinTrials #: BR005: NCT03188393 June 13, 2017

Original languageEnglish (US)
Pages (from-to)777-784
Number of pages8
JournalBreast Cancer Research and Treatment
Volume187
Issue number3
DOIs
StatePublished - Jun 2021
Externally publishedYes

Keywords

  • De-escalation
  • Lumpectomy omission
  • Qualitative

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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