Assessment of Oncologists’ Perspectives on Omission of Sentinel Lymph Node Biopsy in Women 70 Years and Older With Early-Stage Hormone Receptor–Positive Breast Cancer

Key Points Question What are surgical, medical, and radiation oncologists’ perspectives on the omission of sentinel lymph node biopsy (SLNB) in women 70 years and older with early-stage hormone receptor–positive breast cancer? Findings In this qualitative study involving semi-structured interviews of 29 surgical, medical, and radiation oncologists, the decision to omit SLNB involved nuanced patient- and disease-level factors. Wide variation was observed in oncologists’ perspectives on SLNB omission recommendations and supporting data, and participants’ statements suggest that the multidisciplinary nature of cancer care may increase oncologists’ anxiety regarding omission of SLNB. Meaning This study’s findings suggest that interventions aimed at educating physicians, facilitating preoperative multidisciplinary conversations, and improving patient-physician communication may help to appropriately decrease SLNB rates.

[1]  Jessica L. Thompson,et al.  Impact of Choosing Wisely Recommendations on Sentinel Lymph Node Biopsy and Postoperative Radiation Rates in Women Over Age 70 Years with Hormone-Positive Breast Cancer , 2021, Annals of Surgical Oncology.

[2]  Lesly A. Dossett,et al.  Patient Perspectives on Treatment Options for Older Women With Hormone Receptor–Positive Breast Cancer , 2020, JAMA network open.

[3]  D. Ollila,et al.  Trends in Surgical Axillary Management in Early Stage Breast Cancer in Elderly Women: Continued Over-Treatment , 2020, Annals of Surgical Oncology.

[4]  Lesly A. Dossett,et al.  Barriers and Facilitators to De-Implementation of the Choosing Wisely® Guidelines for Low-Value Breast Cancer Surgery , 2020, Annals of Surgical Oncology.

[5]  A. Giuliano,et al.  Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival Among Women With Invasive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alliance) Randomized Clinical Trial , 2017, JAMA.

[6]  R. Jagsi,et al.  Contralateral Prophylactic Mastectomy Decisions in a Population-Based Sample of Patients With Early-Stage Breast Cancer , 2016, JAMA surgery.

[7]  Kathleen A Cronin,et al.  US incidence of breast cancer subtypes defined by joint hormone receptor and HER2 status. , 2014, Journal of the National Cancer Institute.

[8]  R. Birdwell,et al.  Older women’s experience with breast cancer treatment decisions , 2014, Breast Cancer Research and Treatment.

[9]  Barbara L. Smith,et al.  Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[10]  Richard Baker,et al.  A checklist for identifying determinants of practice: A systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice , 2013, Implementation Science.

[11]  P. Boracchi,et al.  Axillary Dissection Versus No Axillary Dissection in Older Patients With T1N0 Breast Cancer: 15-Year Results of a Randomized Controlled Trial , 2012, Annals of surgery.

[12]  S. Sener.  Surgical Complications Associated With Sentinel Lymph Node Dissection (SLND) Plus Axillary Lymph Node Dissection Compared With SLND Alone in the American College of Surgeons Oncology Group Trial Z0011 , 2008 .

[13]  P. Sainsbury,et al.  Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. , 2007, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[14]  Kelly K Hunt,et al.  Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[15]  K. Devers,et al.  Qualitative data analysis for health services research: developing taxonomy, themes, and theory. , 2007, Health services research.

[16]  M. Morrow.  Randomized Trial Comparing Axillary Clearance Versus No Axillary Clearance in Older Patients With Breast Cancer: First Results of International Breast Cancer Study Group Trial 10–93 , 2007 .

[17]  J. Forbes,et al.  A randomized trial comparing axillary clearance versus no axillary clearance in older patients (≥ 60 years) with breast cancer: First results of International Breast Cancer Study Group Trial 10-93. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[18]  Jong-Hyeon Jeong,et al.  Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. , 2002, The New England journal of medicine.