A large number of women with early breast cancer are ER positive and Her-2 negative. Most of these women would receive anti-hormonal therapy. The use of chemotherapy in this group of patients is considered on an individual basis and causes therapeutic uncertainty for both the clinician and patient. 

At present clinicians decide whether to give chemotherapy alongside endocrine treatment based on clinical and pathological factors such as tumour size, grading and nodal status. Adjuvant! Online is a commonly used prognostic tool that uses the same variables to predict the benefit of anti-hormonal and chemotherapy. Patients who are at intermediate risk of recurrence and the decision to give chemotherapy is undecided are the target for this study. 

EndoPredict® is a multigene test used to predict if the cancer might come back in patients who are at intermediate risk of recurrence. The test provides an EPclin score which show the patient to be at either low or high risk of distant metastasis. In the study we looked at both the clinician and the patient’s decision about treatment options pre and post EndoPredict® test results. 

Patients meet with the oncologist post-surgery to discuss their decision around adjuvant chemotherapy. Their tissue was sent for EndoPredict® analysis and they were invited to complete the following questionnaires:

  • Decisional Conflict Scale
  • Speilberger State/Trait Anxiety Inventory

The clinicians were asked about their confidence in deciding whether or not to give chemotherapy using standard criteria.

Patients were invited back for a follow-up appointment to discuss the EndoPredict® test results, where they made a joint decision with their oncologist about whether or not to have chemotherapy. Patients also completed the following questionnaires again:

  • Decisional Conflict Scale
  • Speilberger State

The clinicians were asked to rate their confidence in their decision based on the EndoPredict® test results.

This was a multi-centre study with 7 recruiting centres in the Kent, Sussex and Surrey network. We recruited 151 patients between July 2015 to October 2016 and are currently preparing to publish the results.

 

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