Primary systemic therapy for breast cancer: Does the patient's involvement in decision-making create a new future?

Abstract

Objective: Primary systemic therapy (PST) followed by surgery is the standard initial treatment for locally advanced breast cancer (LABC). However, some patients are averse to mastectomy or breast-conserving surgery and do not consent to these procedures. The reasons for this controversial decision, the factors influencing the decision-making and optimal solutions for decision aiding need to be investigated.

Methods: We addressed these questions by a review of literature on the possibilities associated with different patient choices and subsequent treatment options in relation to LABC.

Results: A total of 5 reviews and 22 clinical studies were summarized in relation to decision making and the most successful decision aids. A discussion is given of the issues of those few patients who cannot be convinced to undergo surgery.

Conclusion: Currently there is no guideline for the treatment of patients who reject the surgical procedures after PST. Medical oncologists should be able to apply decision aid modalities in a personalized manner to give all needed information to their patients thereby ensuring a deliberate decision-making process, facilitating acceptance of a need for surgery, and thus improving the chances of prolonged survival.

Practice implications: Currently multidisciplinary tumor boards are the most suitable decision aids in oncological practice.

Keywords: Breast cancer; Breast-conserving surgery; Decision making; Decision-aid; Primary systemic therapy.