Patterns of care in Dutch postmenopausal patients with hormone-sensitive early breast cancer participating in the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial

Abstract

Background: The Tamoxifen and Exemestane Adjuvant Multinational (TEAM) trial investigates the efficacy and safety of adjuvant exemestane alone and in sequence after tamoxifen in postmenopausal women with hormone-sensitive early breast cancer. As there was a nationwide participation in The Netherlands, we studied the variations in patterns of care in the Comprehensive Cancer Centre Regions (CCCRs) and compliance with national guidelines.Methods: Clinicopathological characteristics, carried out local treatment strategies and adjuvant chemotherapy data were collected.Results: From 2001 to January 2006, 2754 Dutch patients were randomised to the study. Mean age of patients was 65 years (standard deviation 9). Tumours were £2 cm in 46% (within CCCRs 39%-50%), node-negative disease varied from 25% to 45%, and PgR status was determined in 75%-100% of patients. Mastectomy was carried out in 55% (45%-70%), sentinel lymph node procedure in 68% (42%-79%) and axillary lymph node dissections in 77% (67%-83%) of patients, all different between CCCRs (P < 0.0001). Adjuvant chemotherapy was given in 15%-70% of eligible patients (P < 0.001).Discussion: In spite of national guidelines, breast cancer treatment on specific issues widely varied between the various Dutch regions. These data provide valuable information for breast cancer organisations indicating (lack of) guideline adherence and areas for breast cancer care improvement.

Half of breast cancer patients discontinue tamoxifen and any endocrine treatment before the end of the recommended treatment period of 5 years: a population-based analysis

“…This study reports results of observational data, however, some of the patients included in our study cohort might be included in a post-marketing multinational trial [28]. As a result, continuous use of endocrine treatment among these patients might be increased compared to the rates found in daily practice.…”

Quality of life in relation to tamoxifen or exemestane treatment in postmenopausal breast cancer patients: a Tamoxifen Exemestane Adjuvant Multinational (TEAM) Trial side study

“…In the Netherlands, the study was initiated in 76 hospitals and details also have been described previously [13]. The TEAM QoL side study was an open multicenter study in which 45 Dutch TEAM centers participated.…”

Self‐reported cognitive functioning in postmenopausal breast cancer patients before and during endocrine treatment: findings from the neuropsychological TEAM side‐study

“…In view of the growing understanding of the role of estrogens in cognitive functioning, and the resulting concerns about the possible cognitive effects of endocrine treatments in breast cancer patients, we prospectively evaluated the influence of the selective estrogen receptor modulator (SERM) tamoxifen and the aromatase inhibitor (AI) exemestane on self‐reported cognitive functioning and cognitive test performance of postmenopausal breast cancer patients. The current study was conducted in Dutch women participating in the Tamoxifen and Exemestane Adjuvant Multinational (TEAM) trial [25], a prospective randomized study investigating tamoxifen versus exemestane as adjuvant therapy for hormone‐sensitive, postmenopausal breast cancer. Detailed results regarding cognitive test performance have been described elsewhere [26].…”