Utilisation de référentiels et hétérogénéité décisionnelle des indications de chimiothérapie adjuvante dans les cancers du sein exprimant les récepteurs hormonaux, HER2-négatifs: résultats d'un sondage national en France*

Adjuvant chemotherapy for localised breast cancer aims at reducing the risk of relapse and at increasing overall survival. Decision criteria include tumour burden and biological profile. It appears currently difficult to evaluate the benefit/risk ratio in certain borderline cases, which are more and more frequent. We have evaluated through an anonymous web survey conducted as part of the 2013Annual Saint-Paul-de-Vence breast conference, the chemotherapy decisions, use of guidelines and level of certainty with decisions in this type of situation through four clinical cases. The survey was proposed to 1,190French physicians who are directly in charge of breast cancer care, whatever their specialty. Three hundred and fifty-three of them replied, of whom 67% were oncologists and 15% surgeons. A significantly heterogeneous decision was observed for two out of four cases, in which 52and 69% of the physicians opted for adjuvant chemotherapy, versus 48and 21% for abstention respectively. Eighty seven percent of responding physicians used guidelines to guide their decision. These guidelines were regional for 63%, national for 36%, local in 21% and international in 16% of the cases. The level of certainty varied with clinical cases but not with the physician's specialty, nor type of decision.