Clinical practice guidelines for the management of early breast cancer

Guidelines for the treatment of breast cancer.
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Janine
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Clinical practice guidelines for the management of early breast cancer

Postby Janine » Wed Jun 13, 2007 1:44 am

[From the , publications. These Clinical Practice Guidelines can give an indication of how your medical team is thinking. This guideline is current but you'll notice some of the content may be a little dated.]


Second edition
Prepared by the iSource National Breast Cancer Centre
Endorsed August 2001
NHMRC - National Health &Medical Research Council

"Synopsis of publication:
Clinical practice guidelines for the management of early breast cancer aims to be a document useful for both health professionals and consumers. It is designed to:
Assist in decision-making by women and their doctors;
Educate all involved in the care of women with breast cancer;
Assess and assure the quality of care;
Reduce the risk of legal liability by improving care; and
Bring the issue of cost-effectiveness into the public arena.
This book presents guidelines, and does not pretend to be a textbook. Clinicians looking for further information on the biology and natural history of breast cancer should consult the relevant texts.

The guidelines are not rigid procedural paths, nor are they prescriptive. They aim to provide information on which decisions can be made, rather than dictate what the decisions should be.

The guidelines are designed to provide information to assist decision making and are based on the best evidence available at time of publication. They are a guide to appropriate practice, to be followed subject to the clinician's judgement and the woman's preference in each individual case.

This is the second edition of the Clinical practice guidelines for the management of early breast cancer and replaces the first edition released in 1995."


The following table provides a summary of the guideline recommendations presented in this document. All of the recommendations should be considered in the care and management of women with early breast cancer. Readers should turn to the appropriate chapters to understand each recommendation in context of the evidence.
COUNSELLING AND SUPPORT
1. Providing women with support and detailed information about their diagnosis and treatment increases their emotional wellbeing and assists their physical and emotional recovery.
2. Strategies to improve recall of information are recommended, including:
• the provision of a breast care nurse or counsellor
• tape recording of the consultation
• follow-up letter
• psycho-educational programs
3. Counselling is recommended for women with breast cancer, as it improves quality of life.
4. The involvement of a breast care nurse in the treatment team is recommended, as this reduces psychological morbidity.
PARTICIPATION IN CLINICAL TRIALS
5. There is indirect evidence that women who participate in clinical trials have better outcomes than similar women given similar treatment outside trials.
MULTIDISCIPLINARY CARE
6. The outcome of patients with breast and other cancers is better if they are treated by a clinician who has access to the full range of treatment options in a multidisciplinary setting.
SURGERY FOR INVASIVE BREAST CANCER
7. In discussion of the choice between breast conserving surgery and mastectomy, women should be informed that body image is better preserved with conservation surgery.
8. Where appropriate, women should be offered a choice of either breast conserving surgery followed by radiotherapy or mastectomy, as there is no difference in the rate of survival or distant metastasis.
9. For most women with early breast cancer, a level 1 or level 2 axillary node dissection should be standard.
RADIOTHERAPY
10.Radiotherapy after complete local excision (CLE) is recommended as it significantly reduces the risk of local recurrence in the breast and the need for further surgery. It should not be omitted, even in selected patients.
11.Postmastectomy radiotherapy is recommended for women at high risk of local or regional relapse.
SYSTEMIC ADJUVANT THERAPY
12. Under the age of 50 years (pre-menopausal women), ovarian ablation reduces the risk of recurrence and death for women with breast cancer (see Chapter 6, Table 4).
13. Up to the age of 70 years, multi-agent chemotherapy reduces the risk of recurrence and death for women with breast cancer (See Chapter 6, Table 6).
14.Moderately prolonged (several months) combined chemotherapy is recommended as it is more effective than single agent therapy and than treatment lasting less than one month.
15. Anthracycline-containing regimes are superior to cyclophosphamide, methotrexate and 5-fluorouracil (CMF) for both recurrence-free survival and overall survival at the increased risk of alopecia, cardiac toxicity and febrile neutropenia.
16. Dose intensity is important to outcome in adjuvant cytotoxic therapy, at least in dose ranges achievable without colony stimulating factor (CSF) support.
17.Treatment with high-dose chemotherapy outside of clinical trials is not recommended.
18.Women should be fully informed of the short- and long-term effects of cytotoxic chemotherapy on general functioning and on body image, sexuality and fertility.
19.Tamoxifen is recommended for most women with oestrogen receptor positive tumours, as it significantly improves recurrence-free and overall survival in women of all age groups.
20.Tamoxifen reduces the incidence of contralateral breast cancer.
21.Women should be informed of the potential side effects of tamoxifen, including endometrial cancer, stroke, pulmonary embolism, deep vein thrombosis, hot flushes and vaginal dryness and discharge, but not excess weight gain. For most women, the protective effect of tamoxifen against the recurrence of breast cancer will vastly outweigh the increased risk of side effects.
22. Ovarian ablation is more effective in women with oestrogen receptor positive tumours.
COMBINED MODALITIES
23.Chemotherapy in combination with tamoxifen yields an increase in disease-free survival compared with tamoxifen alone.
24.Tamoxifen in combination with chemotherapy yields an increase in disease-free survival compared with chemotherapy alone.
FOLLOW-UP
25. A minimal follow-up schedule is recommended, as there is no evidence that frequent intensive follow-up confers any survival benefit or increase in quality of life."
Janine

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