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SUMMARY Breast cancer is the most common cancer worldwide, with more than half a million new cases reported annually. Evidence-based guidelines for treatment of breast cancer patients are published by several internationally respected physician organizations such as NCCN, ASCO and ESMO. Multiple studies demonstrated that the outcomes for breast cancer patients such as overall survival and recurrence-free survival could be significantly improved if more women were treated according to evidence-based guidelines. As guidelines are often outdated or obsolete shortly after development, it is of great importance to strive for continuous guideline development and updating, especially when important therapy breakthroughs need to be rapidly communicated. More breast cancer guideline summaries understandable to patients should be published, because well-informed patients are their own best advocates and invaluable partners for physicians. Breast cancer patients should be encouraged to talk with their treating physicians about which treatment guidelines they use as the basis of their practice. Future research to determine why many patients fail to adhere to therapeutic guidelines may represent an important research area that could result in improved patient outcomes and survival. Keywords: breast cancer, breast, clinical guidelines, clinical practice guidelines, recommendation, guideline adherence, treatment, outcome, quality of care, BRENDA
Better outcomes for breast cancer patients whose therapy follows evidencebased guidelines Christian F. W. Lenz1, Eva Schumacher-Wulf2, Doris C. Schmitt3 1 Pfizer Global Health and Value, Berlin, Germany 2 Mamma Mia! Das Brustkrebsmagazin, Kronberg, Germany 3 Stiftung PATH/Brustkrebsbiobank, München, Germany
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reast cancer is the most common type of cancer worldwide, with more than half a million new cases reported annually [1]. There are more than twice as many new breast cancer cases annually than new cases of cancer in any other body site [2]. Breast cancer accounts for about a quarter of all cancers diagnosed in women [3] and is the most common cause of death from cancer in women worldwide [4]. In Europe, one in eight women will develop breast cancer before the age of 85 [5]. Despite continuing advances in improving therapy and systemic adjuvant therapies in particular, this disease still represents a therapeutic problem of major relevance to economics and healthcare policy. Selecting the right treatment for breast cancer is a highly complex process, in which a lot of different factors must be taken into account. Some parameters are linked to the disease itself, including hormone receptor and HER2 receptor status, tumor proliferation index, response to previous treatments, tumor molecular signatures, and tumor load. Other aspects to consider include the personal characteristics of the patient, such as age, menopaus-
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al status, comorbidities, adverse effects of previous treatments, psychological and socioeconomic factors, lifestyle and – very importantly – personal preferences. Proper knowledge of the different therapeutic options is necessary to establish optimal and homogeneous treatment sequences. International evidence-based breast cancer guidelines
Although the exact treatment for breast cancer varies from person to person, evidence-based guidelines are used in health care systems throughout the world to aid in treatment decisions and to ensure quality and consistency in patient care. These systematically developed guidelines are based on the latest research and expert consensus, and are regularly updated and posted online. Attributes of good evidence-based guidelines include validity, reliability, reproducibility, clinical applicability, flexibility, clarity, a multidisciplinary process, review of evidence, and documentation. To address the specific clinical question, typically an Expert Panel © VERLAG PERFUSION GMBH