Computer program to assist in making decisions about adjuvant therapy for women with early breast cancer

P M Ravdin ¹, L A Siminoff , G J Davis , M B Mercer , J Hewlett , N Gerson , H L Parker

Affiliations

¹ Division of Oncology, University of Texas Health Sciences Center, San Antonio, TX 78284, USA. pravdin@swog.org

PMID: 11181660
258 citations

Abstract

Purpose: The goal of the computer program Adjuvant! is to allow health professionals and their patients with early breast cancer to make more informed decisions about adjuvant therapy.

Methods: Actuarial analysis was used to project outcomes of patients with and without adjuvant therapy based on estimates of prognosis largely derived from Surveillance, Epidemiology, and End-Results data and estimates of the efficacy of adjuvant therapy based on the 1998 overviews of randomized trials of adjuvant therapy. These estimates can be refined using the Prognostic Factor Impact Calculator, which uses a Bayesian method to make adjustments based on relative risks conferred and prevalence of positive test results.

Results: From the entries of patient information (age, menopausal status, comorbidity estimate) and tumor staging and characteristics (tumor size, number of positive axillary nodes, estrogen receptor status), baseline prognostic estimates are made. Estimates for the efficacy of endocrine therapy (5 years of tamoxifen) and of polychemotherapy (cyclophosphamide/methotrexate/fluorouracil-like regimens, or anthracycline-based therapy, or therapy based on both an anthracycline and a taxane) can then be used to project outcomes presented in both numerical and graphical formats. Outcomes for overall survival and disease-free survival and the improvement seen in clinical trials, are reasonably modeled by Adjuvant!, although an ideal validation for all patient subsets with all treatment options is not possible. Additional speculative estimates of years of remaining life expectancy and long-term survival curves can also be produced. Help files supply general information about breast cancer. The program's Internet links supply national treatment guidelines, cooperative group trial options, and other related information.

Conclusion: The computer program Adjuvant! can play practical and educational roles in clinical settings.

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Full text on Journal of clinical oncology : official journal of the American Society of Clinical Oncology

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Using Probability for Pathological Complete Response (pCR) as a Decision Support Marker for Neoadjuvant Chemotherapy in HER2 Negative Breast Cancer Patients - a Survey Among Physicians. Paul Gass, Michael Untch, +18 authors, Naiba Nabieva. less Geburtshilfe Frauenheilkd, 2018 Jul 31; 78(7). PMID: 30057427 Free PMC article.
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A Comparison Between the Online Prediction Models CancerMath and PREDICT as Prognostic Tools in Thai Breast Cancer Patients. Nuanphan Polchai, Doonyapat Sa-Nguanraksa, +3 authors, Pornchai O-Charoenrat. less Cancer Manag Res, 2020 Aug 06; 12. PMID: 32753968 Free PMC article.
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A nomogram for predicting survival in patients with de novo metastatic breast cancer: a population-based study. Wen Zhao, Lei Wu, +11 authors, Jin Yang. less BMC Cancer, 2020 Oct 14; 20(1). PMID: 33046035 Free PMC article.
Integrated Multiparametric Radiomics and Informatics System for Characterizing Breast Tumor Characteristics with the OncotypeDX Gene Assay. Michael A Jacobs, Christopher B Umbricht, +5 authors, Antonio C Wolff. less Cancers (Basel), 2020 Oct 01; 12(10). PMID: 32992569 Free PMC article.
Long-term outcome and prognostic value of Ki67 after perioperative endocrine therapy in postmenopausal women with hormone-sensitive early breast cancer (POETIC): an open-label, multicentre, parallel-group, randomised, phase 3 trial. Ian Smith, John Robertson, +16 authors, Mitch Dowsett. less Lancet Oncol, 2020 Nov 06; 21(11). PMID: 33152284 Free PMC article.
Nomogram-derived prediction of pathologic complete response (pCR) in breast cancer patients treated with neoadjuvant chemotherapy (NCT). Shengyu Pu, Ke Wang, +4 authors, Jian Zhang. less BMC Cancer, 2020 Nov 21; 20(1). PMID: 33213397 Free PMC article.
Multidimensional Machine Learning Personalized Prognostic Model in an Early Invasive Breast Cancer Population-Based Cohort in China: Algorithm Validation Study. Xiaorong Zhong, Ting Luo, +13 authors, Hong Zheng. less JMIR Med Inform, 2020 Nov 10; 8(11). PMID: 33164899 Free PMC article.
The overall survival of breast cancer patients without adjuvant therapy. Sakura Onishi, Masataka Sawaki, +11 authors, Hiroji Iwata. less Surg Today, 2019 Feb 08; 49(7). PMID: 30730005
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Communicating prognosis to women with early breast cancer - overview of prediction tools and the development and pilot testing of a decision aid. Viktoria Mühlbauer, Birte Berger-Höger, +2 authors, Martina Albrecht, Ingrid Mühlhauser, Anke Steckelberg. less BMC Health Serv Res, 2019 Mar 17; 19(1). PMID: 30876414 Free PMC article. Systematic Review.
Development and validation of nomograms predicting survival in Chinese patients with triple negative breast cancer. Yaping Yang, Ying Wang, +7 authors, Jieqiong Liu. less BMC Cancer, 2019 Jun 07; 19(1). PMID: 31170946 Free PMC article.
Large-scale tumor-associated collagen signatures identify high-risk breast cancer patients. Gangqin Xi, Wenhui Guo, +16 authors, Jianxin Chen. less Theranostics, 2021 Feb 05; 11(7). PMID: 33537084 Free PMC article.
Concordance between results of inexpensive statistical models and multigene signatures in patients with ER+/HER2- early breast cancer. Laurence Slembrouck, Isabelle Vanden Bempt, +12 authors, Giuseppe Floris. less Mod Pathol, 2021 Feb 10;. PMID: 33558657
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Recommendations from the European Commission Initiative on Breast Cancer for multigene testing to guide the use of adjuvant chemotherapy in patients with early breast cancer, hormone receptor positive, HER-2 negative. Paolo Giorgi Rossi, Annette Lebeau, +13 authors, ECIBC Contributor Group. less Br J Cancer, 2021 Feb 19;. PMID: 33597715 Review.
A Phenomic Perspective on Factors Influencing Breast Cancer Treatment: Integrating Aging and Lifestyle in Blood and Tissue Biomarker Profiling. Ainhoa Arana Echarri, Mark Beresford, +6 authors, James E Turner. less Front Immunol, 2021 Feb 19; 11. PMID: 33597950 Free PMC article. Review.

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