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Annals of Oncology Advance Access published online on October 29, 2009
Annals of Oncology, doi:10.1093/annonc/mdp419
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

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

J. G. H. van Nes1, C. Seynaeve2, E. Maartense3, R. M. H. Roumen4, R. S. de Jong5, L. V. A. M. Beex6, W. M. Meershoek-Klein Kranenbarg7, H. Putter8, J. W. R. Nortier9, C. J. H. van de Velde1,* and for the Cooperating investigators of the Dutch TEAM trial

1 Department of Surgery, Leiden University Medical Centre, Leiden
2 Department of Medical Oncology, Erasmus Medical Centre–Daniel den Hoed Cancer Centre, Rotterdam
3 Department of Internal Medicine, Reinier de Graaf Gasthuis, Delft
4 Department of Surgery, Máxima Medical Centre, Veldhoven
5 Department of Internal Medicine, Martini Hospital, Groningen
6 Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen
7 Datacentre Surgery, Leiden University Medical Centre, Leiden
8 Department of Medical Statistics, Leiden University Medical Centre, Leiden, The Netherlands
9 Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands

* Correspondence to: Prof. C. J. H. van de Velde, Department of Surgery, Leiden University Medical Centre, K6-R, PO Box 9600, 2300 RC Leiden, The Netherlands. Tel: +31-71-526-2309; Fax: +31-71-526-6750; E-mail: c.j.h.van_de_velde{at}lumc.nl

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.

breast cancer, endocrine therapy, guideline, patterns of care

Received for publication March 2, 2009. Revision received May 27, 2009. Accepted for publication July 23, 2009.


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