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Relationship between lack of patient compliance with adjuvant therapy guidelines and recurrence in early breast cancer.

215 Background: Modern treatment (Tx) of early stage breast cancer (BC) often requires a combination of surgery, radiation and adjuvant drugs (chemotherapy, hormones and/or Herceptin). Lack of patient compliance is often an issue, due to the prolonged nature of Tx and lack of perceived benefit when there is no clinically overt disease.


METHODS
We retrospectively evaluated consecutive patients with recurrent BC who had primary Tx for stage I-III BC elsewhere, and were seen at MRMC over an eighteen month period by DLC or RN following relapse. Patients with stage IV or inflammatory BC at initial diagnosis were excluded. All patients in this study were therefore considered failures of primary Tx.


RESULTS
A total of 215 patients (median age 44, range 27-74) were included in this study. Sites of recurrence were loco-regional 73, distant mets 117, both 25. 215 (60%) were found to have had inadequate Tx as per NCCN guidelines. The most common deviations from NCCN guidelines were due to patients' refusal of chemotherapy or hormone therapy. Detailed information about nodal status was available for 208 patients (see table). The proportion of patients with 0-3 nodes positive who received inadequate primary Tx was statistically significantly greater than the proportion of patients with > 3 nodes involved (Pearson Chi Square p < 0.0001).


CONCLUSIONS
This retrospective study suggests that patient compliance is a key factor in determining efficacy of primary Tx of early BC. [Table: see text].