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. 2024 Oct;50(10):108585.
doi: 10.1016/j.ejso.2024.108585. Epub 2024 Aug 14.

A multidisciplinary team and patient perspective on omission of surgery after neoadjuvant systemic therapy for early breast cancer: A European Society of Surgical Oncology (ESSO) Research Academy survey

Carmela Caballero  1 , Dara J Lundon  2 , Mariela Vasileva-Slaveva  3 , Giacomo Montagna  4 , Eduard-Alexandru Bonci  5 , Andreas Brandl  6 , Henry Smith  7 , Johnn Henry Herrera Kok  8 , Carl-Jacob Holmberg  9 , Raza Sayyed  10 , Nada Santrac  11 , Ina Suppan  12 , Pallvi Kaul  13 , Nikolaos Vassos  14 , Laura Lorenzon  15 , Marlena Murphy  16 , Wim Ceelen  17 , Evandro de Azambuja  18 , Stuart A McIntosh  19 , Isabel T Rubio  20
Affiliations

A multidisciplinary team and patient perspective on omission of surgery after neoadjuvant systemic therapy for early breast cancer: A European Society of Surgical Oncology (ESSO) Research Academy survey

Carmela Caballero et al. Eur J Surg Oncol. 2024 Oct.

Abstract

Background: Surgical de-escalation aims to reduce morbidity without compromising oncological outcomes. Trials to de-escalate breast cancer (BC) surgery among exceptional responders after neoadjuvant systemic therapy (NST) are ongoing. Combined patient and clinician insights on this strategy are unknown.

Methods: The European Society of Surgical Oncology Young Surgeons Alumni Club (EYSAC) performed an online survey to evaluate the perspective of multidisciplinary teams (MDTs) on omission of surgery ("no surgery") following complete response to NST for early BC. The aim was to identify MDT considerations and perceived barriers to omission of BC surgery. Patient insights were obtained through a focused group discussion (FGD) with four members of the patient advocacy group, Guiding Researchers and Advocates to Scientific Partnerships (GRASP).

Results: The MDT survey had 248 responses, with 229 included for analysis. Criteria for a "no surgery" approach included: patient's tumor and nodal status before (39.7 %) and after (45.9 %) NST and comorbidities (44.3 %). The majority chose standard surgery for hypothetical cases with a complete response to NST. Barriers for implementation were lack of definitive trials (55.9 %), "no surgery" not being discussed in MDTs (28.8 %) and lack of essential diagnostic or therapeutic options (24 %). Patients expressed communication gaps about BC surgery, lack of trust regarding accuracy of imaging, fear of regret and psychosocial burden of choosing less extensive surgery.

Conclusions: Before accepting "no surgery" after complete response to NST, MDTs and patients need level 1 evidence from clinical trials, access to standard diagnostic modalities and treatments. Patient's fear of regretting less surgery need to be acknowledged and addressed.

Keywords: Breast cancer; Breast surgery; Complete response; Neoadjuvant systemic treatment; Optimization; Surgical de-escalation.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Carmela Caballero reports administrative support was provided by Anticancer Fund. Carmela Caballero reports administrative support was provided by European Society of Surgical Oncology. Carmela Caballero reports a relationship with Breast International Group that includes: employment. Carmela Caballero reports a relationship with European Society of Surgical Oncology that includes: board membership. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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