J Cancer 2014; 5(6):491-498. doi:10.7150/jca.9216 This issue

Research Paper

Outcome of Breast Cancer Patients Treated outside of Clinical Trials

Nagi S. El Saghir1✉, Hussein A. Assi1, Sara M. Jaber1, Katia E. Khoury1, Zahi Nachef1, Hana F. Mikdashi1, Nadine S. El-Asmar1, Toufic A. Eid2

1. Breast Center of Excellence, Naef K. Basile Cancer Institute and Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon;
2. Naef K. Basile Cancer Institute and Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon.

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El Saghir NS, Assi HA, Jaber SM, Khoury KE, Nachef Z, Mikdashi HF, El-Asmar NS, Eid TA. Outcome of Breast Cancer Patients Treated outside of Clinical Trials. J Cancer 2014; 5(6):491-498. doi:10.7150/jca.9216. Available from https://www.jcancer.org/v05p0491.htm

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Background: Information on outcome of breast cancer patients treated in the community is scarce. Data on outcome of patients treated in real-life clinical practice may provide useful information for performance improvement.

Methods: Study population is from a single institution practice at the American University of Beirut Medical Center. Demographics, clinical characteristics and survival data on patients diagnosed 1997-2010 in two IRB-approved studies were entered and analyzed on SPSS program. Survival was estimated using Kaplan Meier Method.

Findings: Total was 519 patients. 23.9% had stage I, 39.7% stage II, 30.4% Stage III and 6% stage IV. ER positive in 74.4% of patients. 30.6% of patients <35 had TNBC compared to 12.3% for the whole group. 45.9% of non-metastatic patients had breast-conserving therapy (BCT). BCT rates increased to 64% during the second half of the study, coinciding with increasing awareness and changing cultural mores. 5-year and 10-year overall survivals for stage I were 98.9% and 80.5%, 89.2% and 70.7% for stage II, 67.6% and 35.5% for stage III, and 39.1% and 26.1% for stage IV respectively.

Interpretation: Patients treated outside clinical trials in a multidisciplinary fashion according to guidelines have comparable, and at times better, survival compared to data from trials or population statistics. Locally generated outcome data could be valuable for evaluating results of treatment at individual practices for the purpose of quality assessment and improvement. Our data also provides report of increased rate of breast conserving surgery from Middle East.

Keywords: breast cancer, outside clinical trials, survival, general oncology practice, breast conserving therapy, mastectomy, triple negative, screening, hormone receptors.